Severe hypocalcemia, a difficult endocrine emergency to manage

Abstract

In the practice of Endocrinology, life-threatening complications are rare, but one of them is severe hypocalcemia, which can present with symptoms of tetany, cardiopedal spasm, seizures, decreased myocardial contractility and even death. To reduce morbimortality due to this complication, it is advisable to make an adequate diagnosis of the cause, establish conventional management and in those cases in which preventive management can be established, to do it early and adequately to avoid consequences in the evolution of the patients.

Calcium is an abundant electrolyte in the body, where 99% is bound to the bone in the form of hydroxyapatite and only 1% is part of the soft tissues and extracellular fluids. Its total concentration has narrow ranges between 8.8 and 10.4 mg/dl (2.12-2.6 mmol/l) and ionic calcium has between 1.16 and 1.31 nmol/l (4.65-5.25 mg/dl).

Fifty percent of calcium is in ionic form, 40% is bound to proteins such as albumin and globulins, and the remaining 10% forms complexes with citrates, sulfates and phosphates. The most accurate measurement of this mineral is in ionic form, but in some places this test is difficult to perform and more expensive. Thus, the measurement of total calcium is quite close to the real levels and it is recommended that, in patients with renal or hepatic diseases or malnutrition, the correction with respect to albumin be performed, remembering that 1 g/dl of reduction in the albumin concentration reduces the total calcium concentration by 0.8 mg/dl.