Hypocalcemia and Hypercalcemia By: Faustina, Mia, Kirsten, George, Allie, Chris, Tessa, Kate, Nick, Jennifer, Jenn

Hypocalcemia- Causes Inadequate intestinal absorption, deposition of ionized calcium into bone or soft tissue, blood administration Decreases in PTH and vitamin D Hypoparathyroidism Renal Failure Pancreatitis Nutritional deficiencies occur with inadequate sources of dairy products or green leafy vegetables

Hypocalcemia – Risk Factors P arathryroid disorder (too little parathyroid hormone) E nd-stage renal disease T hyroidectomy S teroids

Clinical Manifestations Hypocalcemia Nursing Implications Clinical Manifestations Monitor PT/INR and PTT Monitor serum calcium, phosphate, magnesium, and vitamin D Assess and treat pain Identify and treat underlying causes (hypoparathyroidism) Continuous cardiorespiratory monitoring Focused cardiac assessment Seizure precautions Fall precautions Neuromuscular Irritability (Tetany) Cardiac arrhythmias (QT prolongation) Muscle spasm Paresthesias Intestinal cramping Hyperactive bowel sounds

Hypocalcemia – Signs Trousseau’s sign (hand/finger spasms) Watch for arrhythmias (Prolonged QT interval, cardiac arrest…) Increase in bowel sounds, diarrhea Tetany Chvostek’s sign (facial twitching) Hypotension, Hyperactive DTR

Hypocalcemia – How to Correct S eizure precautions A dminister calcium supplements F oods high in calcium (i.e. dairy, and greens ) E mergency equipment on standby

Hypercalcemia – Causes C Calcium supplementation H Hyperparathyroidism I Iatrogenic, immobilization M Malignancies P Parathyroid hyperplasia or adenoma

Hypercalcemia- Physical manifestations Most pts. with hypercalcemia do not have specific findings on physical assessment Hypercalcemia – excess calcium blocks channels, raising threshold for depolarization. This leads to… CNS effects: Lethargy, weakness, confusion, coma Renal effects: Polyuria, nocturia, dehydration, renal stones, renal failure GI effects: Constipation, nausea, anorexia, pancreatitis, gastric ulcer Cardiac: Shortened QT intervals, depressed T-wave, bradycardia, heart block

Hypercalcemia- Nursing Implications Perform an ECG Check for changes associated with hypercalcemia (short QT interval and short ST segment) Encourage fluid intake Facilitates calcium excretion by kidneys Monitor intake and output Restrict dietary calcium intake Increase patient mobility Identify and closely monitor patients with increased risk Hyperparathyroidism, cancer, prolonged immobility, thiazide diuretics, kidney transplant

Hypercalcemia- How to Correct Administration of normal saline and diuretics Speed up dilution and excretion Administration of calcitonin or steroids Force the circulating calcium into the cells Administration of bisphosphonate drugs Prevents bone breakdown caused by malignancy Treat underlying disease Dialysis Alternative if other treatments fail and kidneys have severe damage Can help rid blood of extra calcium and waste