ISSN: 1305-3876
Dil: Türkçe
Hakkında: Özel sayılar şeklinde yayınlanır.
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Hypocalcemia ın Endocrine Emergency And Treatment Of Acute Hypocalcemic Crisis
Dr. Mithat BAHÇECİ,a Dr. Şenay ARIKANa
aEndokrinoloji BD, Dicle Üniversitesi Tıp Fakültesi, DİYARBAKIR
Serum calcium levels maintain a narrow range that 8,5-10,5 mg/dL under the normal conditions. Calcium is critical for normal cell fonction, neural transmission, membran stability, bone structure, blood coagulation, and intracelluler signaling. Hypocalcemia is defined as serum ionised calcium level less than 4,2 mg/dl. The causes of hypocalcemia are hypoalbuminemia, hyperphosphathemia, hypomagnesemia, surgerical effect, PTH deficiency or PTH resistance, vitamin D deficiency or resistance. Hypocalcemic patients may be completely asymptomatic or, tetany and convulsions due to increased neuromuscular irritability, paresthesias of peroral area, fingertips, carpopedal spasm, spontan painly muscle cramps, bronchospasm, syncop, congestive heart failure, angina pectoris, laringeal stridor, hypotension, and arrhythmia may occur in acute hypocalcemic chrisis. Mild hypocalcemia (ionised calcium levels are 3.2-4.2 mg/dl ) is not life threatening. There is adeqeate time to measurment of ionised calcium and performe other laboratory tests. Elemental calcium is usually sufficient in outpatient conditions that recommended dose is 1-3 gr/d orally. But, severe hypocalcemia (ionised calcium levels are <3,2) is life-treatening, emergency treatment should requare. In patients with symptomes of severe hypocalcemia, intravenous replacement doses of 100-300 mg of elemental calcium should be given over 5-10 minute togather with listen to heart sounds. This dosage raises the ionised calcium levels to 2-3 mg. Calcium infusions drips should be maintained to 0,5 mg/kg/ hour due to this effect last 1-2 hours. Calcium for infusion should be diluted in saline or dextrose solution to avoid vein irritation. Oral elemental calcium with 1-3 g/d or vitamin D neccecarily should be added treatment with calcium infusion. To remmember that hypomagnesemia will accampanied with every hypocalcemic case, magnesium sulphate sould be given in patients with magnesium defficiency.Keywords: Hypocalcemia, tetany, ionised calcium, hyperphosphatemiaTurkiye Klinikleri J Surg Med Sci 2006, 2(7):50-56
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