What are the other Names for this Condition? (Also known as/Synonyms)

• Adult Hypocalcemia
• Deficient Blood Calcium in Adults
• Hypocalcaemia in Adults

What is Hypocalcemia in Adults? (Definition/Background Information)

• Hypocalcemia in Adults is a condition characterized by low calcium levels in blood in adults. It can be described as either transient, intermittent, or permanent; among which, the transient type is the most prevalent of the three types
• Adult Hypocalcemia may be caused by reduced dietary intake of calcium, improper functioning of the parathyroid glands, vitamin D deficiency, kidney malfunction, the use of certain drugs, etc.
• Since calcium is essential for the development of bones, teeth, and hair, Adult Hypocalcemia signs and symptoms include bone abnormalities, lesions in skin, twitching, numbness, seizures, and erratic heart rhythms
• The treatment measures for the condition involves the administration of intravenous or oral calcium supplements, as well as addressing the underlying causative condition of hypocalcemia
• The prognosis of Hypocalcemia in Adults depends on the type of pre-existing condition, the severity of the presenting symptoms, and one’s response to treatment. In many cases, the prognosis is generally good

Who gets Hypocalcemia in Adults? (Age and Sex Distribution)

• Hypocalcemia in Adults can occur in adults of any age, gender, race or ethnicity 
• Most cases of Hypocalcemia in Adults are of the transient type; the intermittent type and the permanent type are relatively rarer

What are the Risk Factors for Hypocalcemia in Adults? (Predisposing Factors)

The risk factors for Hypocalcemia in Adults may include:

• Malnutrition and/or vitamin D deficiency
• Kidney disease: Kidney failure is one of the most common reason for Adult Hypocalcemia
• Hyperphosphatemia or elevated phosphate levels in blood
• Hypoparathyroidism or low levels of parathyroid hormone
• Surgical removal of the parathyroid gland(s) or thyroid gland
  • Reduced blood/serum calcium with clinically significant symptoms have been reported in over 50% of individuals following surgery to remove the parathyroid glands
  • Similarly, 19-38% of those with surgical removal of thyroid gland may show a transient drop in serum calcium levels
  • It is reported that less than 2% of Adult Hypocalcemia cases following a surgery may be permanent
• Infections
• Use of chemotherapeutic drugs

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Hypocalcemia in Adults? (Etiology)

Hypocalcemia in Adults may be caused by a number of factors as outlined below:

• Hypoalbuminemia, or decreased albumin protein in blood, which may result from the following conditions:
  • Kidney dysfunction such as nephrotic syndrome
  • Liver cirrhosis
  • Malnutrition
  • Volume overload in heart chambers
  • Other chronic illnesses
• Vitamin D deficiency that may result from:
  • An inadequate intake of vitamin D
  • Disorders of vitamin D metabolism
  • Liver disorders that can increase vitamin D breakdown in the body
• Hyperphosphatemia, or increase in the levels of phosphate in blood, which can result in precipitation of calcium and phosphate. This may be caused by the following conditions:
  • Kidney failure
  • Chemotherapy
• Magnesium depletion in serum (blood)
• Hypoparathyroidism: Parathyroid hormone (PTH) is secreted by the parathyroid glands. Normal PTH levels and activity are crucial for maintaining blood calcium levels. Hypoparathyroidism is a decrease in the levels of PTH, which may result from any of the following conditions:
  • Autoimmune disorders that cause inflammation of the parathyroid glands and suppress PTH synthesis (such as parathyroiditis)
  • DiGeorge syndrome, characterized by malformation of several body tissues and organs, including the parathyroid glands
  • Pseudoparathyroidism in which the levels of PTH are normal, but the PTH receptor is dysfunctional
  • Certain disorders, such as Wilson’s disease, which can lead to a decrease in PTH levels
  • Surgical removal of parathyroid gland(s)
  • Hungry bone syndrome that result from a removal of the parathyroid glands. Reduced levels of PTH may result in reduced levels of phosphate and magnesium in serum, causing significant and sustained hypocalcemia
  • Surgical removal of the thyroid gland that may compromise the parathyroid glands
  • Severe burns
  • Sepsis
  • Other severe illnesses
• Intestinal health issues that may arise due to infections, inflammation, surgery or medications, can cause malabsorption syndrome. This condition can lead to decreased absorption of nutrients, including vitamin D
• Acute pancreatitis (inflammation of the pancreas) can cause calcium to be precipitated in the abdomen, causing reduced calcium levels in blood
• Blood transfusions, where blood may contain chelating agents, such as ethylenediaminetetraacetic acid (EDTA) or citrate, which may precipitate calcium and cause its levels to drop in blood
• Bone metastasis (osteoblastic metastasis) of certain cancers, such as breast cancer or prostate cancer, can cause calcium deposition in the metastasized bone, leading to reduced blood calcium levels

What are the Signs and Symptoms of Hypocalcemia in Adults?

The signs and symptoms of Hypocalcemia in Adults may vary in type and severity among affected individuals. The signs and symptoms may include:

• Dry skin, brittle nails, and coarse hair
• Weakness
• Muscle twitching
• Muscle cramps, more commonly in legs and back
• Temporary inability to speak (laryngospasm)
• Tingling or “pin prick” sensations (parasthesia)
• Numbness
• Twitching of facial muscles when the arc over the facial nerve is tapped (Chvostek’s sign)
• Bone abnormalities; fragile bones leading to fractures
• Developmental delay
• Breathing difficulty; rapid breathing
• Rapid heartbeat
• Abnormal heart rhythm
• Seizures
• Confusion
• Depression
• Hallucinations

How is Hypocalcemia in Adults Diagnosed?

The diagnosis of Hypocalcemia in Adults is made by the following tests and exams:

• A thorough physical examination and assessment of signs and symptoms
• Evaluation of the medical history of the affected individual
• Blood test to check total and ionized calcium levels: The total calcium measures both free and bound forms of calcium in blood. The ionized fraction is the free calcium and is considered the active form. An adult is considered hypocalcemic, if the serum concentration falls below the following values:
• 8.5 to 10.5 mg/dL of total calcium
• 4.65-5.25 mg/dL of ionized calcium
• Blood tests to check for levels of parathyroid hormone, magnesium, albumin, vitamin D and phosphate 
• Additional tests, pertaining to causative conditions that led to Adult Hypocalcemia may be necessary for an accurate diagnosis and treatment

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Hypocalcemia in Adults?

The following are some potential complications of Hypocalcemia in Adults, if the condition is not diagnosed or treated in a timely manner:

• Progression to chronic hypocalcemia
• Bone disease, causing an increased risk for fractures
• Basal ganglia calcification, which can result in movement disorders, seizures, and bleeding within the brain
• Sudden loss of consciousness
• Forgetfulness
• Injuries due to seizures
• Dysfunction of cardiac muscles can lead to sudden cardiac arrest, which can be life-threatening

How is Hypocalcemia in Adults Treated?

Treatment options for Hypocalcemia in Adults may depend on the severity of symptoms and the presence of any underlying condition. The treatments may include:

• Administration of intravenous (IV) calcium gluconate for acute calcium deficiency
• Oral calcium supplements for chronic Adult Hypocalcemia
• Oral vitamin D supplementation
• Medication for infections, if needed
• Additional treatments as deemed necessary by the healthcare provider, to address any underlying condition that caused Adult Hypocalcemia

How can Hypocalcemia in Adults be Prevented?

• If Hypocalcemia in Adults occurs as a consequence of congenital disorders (such as DiGeorge syndrome); then, there are no methods or guidelines available for its prevention
• Seeking medical attention for any condition that may lead to hypocalcemia is necessary to prevent the condition
• Regular medical screening at periodic intervals with tests and physical examinations are strongly recommended

Active research is currently being performed to explore the possibilities for treatment and prevention of conditions such as Hypocalcemia in Adults.

What is the Prognosis of Hypocalcemia in Adults? (Outcomes/Resolutions)

• The prognosis of transient Hypocalcemia in Adults is generally good in most cases; an appropriate treatment can lead to the restoration of normal calcium levels in blood
• However, if life-threatening complications, such as a cardiac arrest arise, the prognosis may be guarded
• The prognosis may be also dependent on the severity of the underlying causative condition

Additional and Relevant Useful Information for Hypocalcemia in Adults:

Calcium is an important mineral for several cellular functions, which ultimately impact the whole body. Calcium is needed for the following functions in the body:

• Cell-cell communication
• Muscle contraction
• Conduction of nerve signals
• Activation of enzyme cascades
• Blood clotting, since calcium is also known as coagulation factor IV, and is required for certain enzymes in the clotting cascade to work effectively
• Exocrine secretions such as bile and pancreatic juice