Hypocalcemia (Low Calcium) Pathology, Causes, Symptoms and Treatment, Animation

(USMLE topics) Calcium metabolism and hypocalcemia: causes, symptoms, pathology, treatment.
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Voice by: Ashley Fleming
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In the body, most calcium is located in bones, only about 1% is in the blood and extracellular fluid. The amount of calcium in circulation is regulated by 2 hormones: parathyroid hormone, PTH, and calcitriol. When serum calcium level is low, PTH is UPregulated. PTH acts to PROMOTE calcium release from bones and REDUCE calcium loss from urine. At the same time, it stimulates production of calcitriol, which promotes absorption of calcium in the small intestine while also INcreases RE-absorption in the kidney. Together, they bring UP calcium levels back to normal. The REVERSE happens when calcium level is high. This feedback loop keeps serum calcium concentrations within the normal range.
HYPOcalcemia refers to ABnormally LOW levels of calcium in the blood and is generally defined as serum calcium level LOWER than 2.1 mmol/L. Because the total serum calcium includes albumin-bound and free-ionized calcium, of which only the LATTER is physiologically active, calcium levels must be corrected to account for albumin changes. For example, DEcreased albumin levels, such as in liver diseases, nephrotic syndrome, or malnutrition, produce LOWER serum calcium values but the amount of FREE calcium may STILL be normal. On the other hand, in conditions with high blood pH, albumin binds MORE calcium; leaving LESS FREE-ionized calcium in the serum while the total calcium level may appear normal.
The most common cause of hypocalcemia is PTH deficiency resulting from DEcreased function of the parathyroid glands, or HYPOparathyroidism. HYPOparathyroidism, in turn, may be caused by a variety of diseases and factors. These include:
accidental removal or damage of the parathyroid glands during a surgery
autoimmune disorders
congenital disorders: mutations that set the “normal calcium levels” to a lower value
other genetic disorders that produce underdeveloped or non-functional parathyroid glands
magnesium deficiency
Other causes of hypocalcemia include low vitamin D intake/production, and excessive loss of calcium from the circulation such as in kidney diseases, tissue injuries or gastrointestinal diseases.
While chronic moderate hypocalcemia may be Asymptomatic, ACUTE and severe hypocalcemia can be life-threatening. Most symptoms of acute hypocalcemia can be attributed to the effect it has on action potential generation in neurons. Because extracellular calcium INHIBITS sodium channels, and consequently DEpolarization, REDUCED calcium level makes it EASIER for depolarization to occur. Hypocalcemia therefore INCREASES neuronal excitability, causing neuromuscular irritability and muscle spasms. Early symptoms often include numbness and tingling sensations around the mouth, in the fingers and toes. As the disease progresses, muscle spasms may manifest as tetany, wheezing, voice change, and dysphagia. Seizures may occur in severe cases. Effects of hypocalcemia on cardiac function include long QT interval due to prolonged ST fragment, congestive heart failure and hypotension.
Acute hypocalcemia should be treated promptly with intravenous calcium. Chronic hypocalcemia is usually treated with oral calcium and possibly vitamin D supplementation.

[@Alilamedicalmedia]

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[@ahmedtzaki4476]

Thanks so much. You helped me a lot. Can you also explain hyper- and hypomagnesemia?

[@katharina6865]

Thank you! Only have 2 Parathyroids left after a messed-up surgery. Struggle every day with supplement needs.

[@themockingjay3173]

My dad had hypocalcemia .. it took about 10 or 15 to re infused with calcium gluconate ... And we still lookin for the right treatment ....

[@AncientViolin]

He should get plenty of sunlight in his cheeks

[@holliss5]

I'm having low calcium after a thyroidectomy I keep having infusions and then it drops again

[@tom46970]

@@holliss5 Hello! Were they able to stabilize your calcium levels? I very recently had a parathyroidectomy. After surgery my calcium started to creep up then crashed. I was on a constant calcium IV for a couple days on top of oral calcium. Then they gave me 3-4 small bags of calcium IV per day with oral calcium for a few days. Now I’m just doing the oral calcium. Hopefully my levels continue to build! I am praying that they get yours to an acceptable level as well!

[@holliss5]

Thanks they are still trying to get the calcium right I'm having infusions twice a week, I have lymphoma and thyroid cancer so am battling two cancers, the chemo isn't causing problems but the lack of calcium is a pain

[@aliciav89fyi]

@@tom46970 what calcium supplement are you taking ?? I have had a complete parathyroidectomy and my calcium is always so low.

[@DarthHater100]

Wonderful video. I really needed that animation with the albumin and Ca++.

[@seshagopalan8416]

same here

[@y64]

Same! I was so confused about the relationship between Albumin and Calcium but this was crystal clear

[@Canucksway]

Most Calcium deficiency symptoms 1. Fatigue 2. Poor oral health ( Tooth decay ) 3. Muscle pain and spasms 4. Cognitive issues 5. Numbness and tingling in your fingers 6. Seizures 7. Abnormal heart rhythm 8. Osteoporosis 9. Weak and brittle nails 10 .Depression 11. Dry skin 12. Muscle cramps 13. Confusion or memory loss 14. Hallucinations 15. Easy fracturing of the bones 16. Difficulty sleeping Dangerously low calcium level? Severe hypocalcemia, defined by a serum calcium

[@mertarican5456]

thank you

[@fivestar-vp7mk]

Dizziness?😢im hypocalcuimiem patient.full tenstion..hb low

[@Canucksway]

@@fivestar-vp7mk Eating foods that have a lot of salt (sodium) causes your body to lose calcium and can lead to bone loss. Try to limit the amount of processed foods, canned foods and salt added to the foods you eat each day. To learn if a food is high in sodium, look at the Nutrition Facts label. Good sources of calcium include dairy foods like milk, yoghurt and cheese, calcium fortified foods (such as soy products) and, to a lesser degree, some leafy green vegetables and nuts and seeds. If you don't have enough calcium in your diet, you may be at increased risk of developing osteoporosis. A few weeks of adequate calcium intake should be enough to boost your levels, but again, another blood test is the only way to know for sure.

[@summersifysummers4702]

THANKS!

[@Canucksway]

@@summersifysummers4702 😉Thank you !

[@rashmitaacharya8653]

Was always confused regarding Mechanism of carpopedal spasm due to hypocalcemia . Thanks !!

[@user-wi7kw4df7z]

I suffer from this and it is truly one of the scariest, most painful spasms I could never imagine till i first experienced it while I was in hospital. They can last for a long time and the pain can be mild to ‘I need to cut my hand off’ unbearable

[@rashmitaacharya8653]

@@user-wi7kw4df7z 😥 thats so sad u have to go through all this.. take care dear

[@flightofideasnx]

Thank you for this video! Your overview of the physiologic function of calcium really helped me understand why certain symptoms manifest for hypocalcemia :)

[@samiha6265]

Nice kind of explanation please make me much informed about hyperglycemia... loved this video

[@jonogyde8464]

i was born with a calcium deficiency 40 years ago am still fine been on Calcitrol meds all my life and i have a rare type that when i dont have my meds for a week or 2 i have a fit seizure very scary but learnt my lesson on that now .

[@tracysmith-yv5lt]

im 50 now must have had it for around 40 years before the doctors found out by mistaking and gave me to much calcium made it go up to 3.8 nearly wacked my kidneys went to 35% just got to the hospital in time and had to make it go back down again to normal is there any one the same age as me on the menopause just starting mine pre-menopause a little low the last blood test but i was sick at the time with a bad cold

[@asmafadhel5221]

Literally, that's what I wanted to know

[@seavista4810]

Thank you 😊...Very Useful in my current situation...🙏

[@newangelz4191]

Beautiful explanation. Thank you so much for this ✨💫

[@matt33876]

I've had this for almost 10 years. There's a ton more symptoms they don't recognize. Such as, exercising during a low episode is very bad to the muscles and body. I certainly don't recommend any hard exercise unless you are stable. The muscles do not recover properly.

[@planetarian451]

You ate certainly right about that. I injured my shoulders working out because of this low potassium body of mine. Both my shoulders have a crackling sound now

[@halilozgur6971]

İts 3 months for me still i have symptoms, how long it took for recovery for you?

[@Dr.Mohamed.Elhenawy]

Very Useful 💛💛

[@ngakuchang1758]

I have calcium diffeciency,I had suffered a lot and now I'm consuming Calcium tablet as prescribed by family doctor.

[@bibekthakur4003]

How r u feeling then

[@Jose-tx1yx]

I wish you explained the physiology of hypocalcemia within heart conduction like you did with hyper/hypokalemia.

[@AntonioDal.]

Im gonna give Calcium supplements a go for a few months. Started suffering from seizures last 3 months. Last 2 years I have chestbone and shin pain. Got tested for Vit D which was very good. My eyelid is also twitching a lot. Heartbeat is irregular often. Really hoping calcium supplementing is gonna help me.

[@clubdredd1337]

Check your pancreas, check your insulin levels. Going threw the same thing for 5 years just came across this. There is a Pdf file online of a case of a person with no history of health problems having seizure. which led to dr to test and found high lipid levels caused acute pancreatitis which found they had hypocalcemia.

[@winteryoung4237]

Are you a dialysis patient?

[@bigfonzostokes]

Check Magnesium And Potassium Levels.

[@m.b305]

I think u need Magnesium

[@victorakale4403]

Look for Jamaican sea moss

[@محمدضياءمحمدأحمدالمالكي]

I have 2 Question : 1- how tingling and numbness occur ( whats the mechanism that related to calcium ) ? 2- when u give calcium gluconate , u have not change any thing because its complex form and inactive ?

[@mertarican5456]

Calcium gluconate does not require hepatic metabolism for the release of Ca++ and is as effective as calcium chloride in treating ionic hypocalcemia in the absence of hepatic function. so my guess would be it just ionises after first pass metabolism

[@annjean8709]

Great tutorial video! Thank you for sharing.

[@AmeerHamza-yj4hr]

Awesome videos very brief and full of concepts ! Just start making videos again

[@ishanipoornima6878]

Thank you so much

[@kamazimargen7697]

Tnx for sharing this video host 👍

[@Aesthetic_leen]

Can calcium deficiency cause lump in the throat feeling... Im low in vit d and also having other symptoms like chest pain breathing issues, tingling etc

[@itsallaboutentertainment1791]

I saw ur comments every where I think u and me are getting same symptoms plz Can u give me some kind of social media I want to talk to u ..

[@Sandro-qq4xb]

@@itsallaboutentertainment1791 Hi, there! I also suffer from the same symptoms she mentioned. Do you still exhibit them? I have them now and i'm about to get my bloodwork next week.

[@anhelvillado7909]

Im a patient of papillary thyroid carcinoma stage 1 im always feeling numbness anxiety .

[@holliss5]

I've had a thyroidectomy and now am getting cramps all over my body and legs due to low calcium I hope the doctors can sort this out soon

[@rakeshthakur5630]

Doctor swelling in ankles and feet can u plz tell me it's normal and not at all..and is low calcium in body can cause swelling in ankles and feet ..plz tell me?

[@timewilltell1939]

Look into potassium and water retention, Eric berg

[@yashpd2653]

I loved the voice! 👌

[@jr5389]

WOW 🤩 What an Excellent 👌 informative video 👍🏴󠁧󠁢󠁳󠁣󠁴󠁿😎

[@shaguftamughal2289]

Very nice 👍🏼

[@surekha5215]

What is early sign of hypocalcemia

[@saritayadav7768]

tnqquuu it's so helpful,,, make more video on ecg and some clinical topic of surgery and medicine

[@samuelpepys1199]

Beyond correcting for just albumin, a novel and simple way of approximating ionized calcium can be seen by searching web with the terms: Ionized Calcium Calculator; 704; medscape REF: Clinica Chimica Acta 531:375, 2022

[@californiahighdesertpreach2261]

Why roll does kidney disease play in effecting calcium uptake? Can the thyroid be to blame alone, with out the kidney?

[@green15838]

Adding k2 and more magniesium,d3,boron can begin muscle cramps or twitches in muscles because low calcium in the muscles.I think when this happens use a calcium supplements and cramps and twitches will go away.

[@AbhishekYadav-cr3xu]

Can you please upload a video on Nephrotic syndrome

[@iba423]

Excellent. .....

[@OhMyGod4445]

I might have this because my muscle cramps frequently and I have tingling

[@shivisharma8391]

Ur problem resolved..?

[@OhMyGod4445]

@@shivisharma8391 It’s long gone

[@shivisharma8391]

@@OhMyGod4445 which medicine you took

[@dougdoug9223]

Same here. Were you deficient?

[@Scienceconceptss]

​@@OhMyGod4445what did u do ? Kindly help

[@vikramadityajha8924]

Wonderful

[@kamazimargen7697]

I full support is done my New friend ❤️

[@medini2]

Should calcium channel blockers be given (IV) or taken PO as needed for tachycardia episodes, when vitamin D and Calcium are LOW?

[@shujathussainn]

What about role of calcitonin from thyroid ?

[@MelikaSalari]

Thank you

[@themshmshman4525]

So , blood albumin level doesn’t affect free ionized calcium , right ? I need an answer 😓 with the reference if it available!

[@suzzy4408]

"The total serum calcium level may be low because of hypoalbuminemia, and the ionized calcium level could be within normal range. With a low albumin or protein level there is more free ionized calcium available".(Handbook of fluid, electrolyte and Acid-Base imbalances).

[@beckiwildeman600]

Wow numbness and tingling around the mouth this symptom is also with in B-6 and B-12 deficiency. Is there any other vitamin deficiency that has this same symptom to it?

[@Alessandro92772]

Thank you 🙏👍👌

[@SquidMinecraft]

somebody answer please... Can a person with hypocalcemia survives living in a cold weather country like canada?

[@lydiahildaasamoah8034]

I am a hypocalcemia patient and have live on the vitamin D and calcium gluconate iv injection since 2008 till date and please needs help I lost my parathyroid glands and the thyroid glands during a major surgery.

[@subhankarroy9466]

Now your calcium level is normal....

[@xacxoc423]

Tnx

[@Blackluck9647]

Is numbness in the legs for long period of sitting like 15 mins and above and sounding of bones when moving are symptoms?

[@scorebig2476]

Sadly yes I am facing these from last 2 yrs

[@rahulsingh53754]

@@scorebig2476 how's your symptoms now?

[@Skybluewindcool]

@@rahulsingh53754 Your Calcium level in the blood is ?

[@rahulsingh53754]

@@Skybluewindcool in normal level

[@sprintingoni8828]

I'm learning all about calcium now that I'm post- op (I had a total thyroidectomy and neck dissection) so I guess my parathyroid is confused? It's good to know about it, I'd like to keep the muscle spasms to a minimum

[@julianavargas965]

What are you taking for muscle spasms? Has your calcium gone down?

[@sprintingoni8828]

@@julianavargas965 I'm taking calcium carbonate suppliments to keep my calcium from getting low. Which prevents muscle spasms

[@parkourparkour4337]

@Sprinting Oni hello, i read your post and wanted to know how you deal with your seizures and how long have you been sick? what do doctors and specialists say? Have you tried any treatments or medications? what do doctors and specialists offer? which specialist are you? Do you have seizures all the time? what are all your symptoms? Sorry for asking so many questions, thank you very much

[@holliss5]

Me too it's so painful

[@subhankarroy9466]

​​@@sprintingoni8828 hello Now are you good.. Your calcium level is normal.. How many calcium supplements should be taken daily?

[@demorrobinson210]

I have muscle twitches so much 😭😭and it won’t stop

[@fz2884]

Me too take your calcium with vitamin d i have muscle weakness too

[@parkourparkour4337]

@Demor Robinson hello, i read your post and wanted to know how you deal with your seizures and how long have you been sick? what do doctors and specialists say? Have you tried any treatments or medications? what do doctors and specialists offer? which specialist are you? Do you have seizures all the time? what are all your symptoms? Sorry for asking so many questions, thank you very much

[@MeloDee1]

@@fz2884 have your symptoms solved know ? I get twitches all over my body as well…

[@jopetsu]

​@@MeloDee1 have you?

[@MeloDee1]

@@jopetsu I made this comment 2 years ago but I’m happy to help 😂. Bro you just need stay busy. I work full time and go gym almost everyday. If I’m not at the gym it’s a bodyweight workout.

[@ThatHippyDuck]

i struggle with low calcium from a parathyroidectomy. keeping my levels above 8.4 is not easy. the amount i take in supplements never seems to do the job and i'm left with brain fog, weakness and sometimes cramping and numbness

[@RapYouCanUnderstand]

Calcium is opposed by magnesium. If you are getting too much magnesium in your diet it will block out the calcium

[@norimeshau7638]

@@RapYouCanUnderstandthey say magensium is good with vitamin D, or u mean very high doses of magnesium?

[@luispinto610]

No tiene video en español ??

[@Alilamedicalmedia]

Hay subtítulos en español en este video.

[@adonistech6940]

I have low-ionized calcium is 3.96 And normal range in the laboratory is 4.50--5.23 My vitamin D test is 22.2 The normal range is 30 But my total calcium is good I have a server headache and insomnia I feel my leg moves by itself Like restless leg syndrome especially when I rest or try to sleep I can't concentrate on anything Can ionized calcium cause this? And what are the reasons for it?

[@autisticcabbagegaming7983]

i have the exact same symptoms and results as you. my vit D was 9ng/ml and my serum calcium is "normal".

[@norimeshau7638]

@@autisticcabbagegaming7983do the test again, a level 9 of vitamin D your calcium levels should be low or very low

[@fivestar-vp7mk]

Dizziness??

[@Scienceconceptss]

​@@autisticcabbagegaming7983how are you now? I am having same symptoms but in hand ..what should I do ..kindly help

[@sinchanam2191]

Nice

[@abdurrahmanabdurrahman9836]

I'm suffering from hypocalcemia since from birth and now I'm 23yrs old what is the best treatment for me

[@26nishit]

Caco3 with curd first thing in the morning...1 month and results are good..

[@olidas6483]

Change in food you need

[@parkourparkour4337]

@abdurrahman abdurrahman hello, i read your post and wanted to know how you deal with your seizures and how long have you been sick? what do doctors and specialists say? Have you tried any treatments or medications? what do doctors and specialists offer? which specialist are you? Do you have seizures all the time? what are all your symptoms? Sorry for asking so many questions, thank you very much

[@subhankarroy9466]

@abdurrahmanabdurrahman9836 How many calcium supplements should be taken daily?

[@artisthindustani]

Good

[@hebamahmmoud1731]

Thank million time 💋💋💋💋

[@odalysmelillo6722]

Que lo pongan en español. Gracias

[@laylam4241]

Hmm what happened to calcitonin?

[@Alilamedicalmedia]

At 0:32

[@TARP..]

I've had calcium deficancy for years my first flat I didn't want electric or gas all the shared houseing uht milk in my room sometimes that's it how do homeless get calcium MILK.. so from now on I drink milk often but no.. I've had 6% max of dairy in 3 years cause I can't leave open containers anywhere ..my oil comes with me everywhere and razors so I always have a bag I could get lockbox soo but I like bag

[@viv1sharma]

My kft profile with calcium is 5.6 mg/dl. Is this normal pls tell I am really worried 😭

[@WENG4898]

Mine is only 2

[@subhankarroy9466]

Now your calcium level is normal..?

[@vishnumaya4169]

🙏

[@maythamtalal3505]

👏🏻👏🏻

[@ManishYadav-os5iu]

Sweaty