Calcium

1. HyperParathyroidism
2. Malignancies
3. Prolonged Immobilization
4. Vitamin D overdose or Excessive Ca+ intake

Annotations:

• Reduced Excitability of Both Muscles & Nerves

1. Lethary, Weakness
2. Depressed reflexes
3. Decreased Memory
4. Polyuria/dehydration
5. Confusion, Personality Changes or Pychosis
6. Anorexia, N&V
7. Bone Fractures
8. Constipation
9. Heart Block Risk

1. Loop Diuretics
2. Hydrate with Isotonic Fluids
3. 3000-4000ml to prevent kidney stone & promote renal excretion
4. low Ca+ diet & Weight Bearing excercise
5. Calcitonin (IM/IV) Nasal not effective
6. Biphosphonate (Zoledronic Acid)

1. Low Albumin Levels
2. Alkalosis (symptomatic hypocalcemia)
3. Multiple blood Transfusions (citrate used to anticoagulate binds w/ Ca+)
4. Laxatives or Malabsorptive syndromes
5. Acute Pancreatitis
6. Increased intake of phosphorus antacids
7. Vitamin D deficiency, Decreased Ca+ intake

1. chvotek's sign
   1. Twitching of the cheek occurs in response to tapping over the facial nerve
2. Trousseau's sign
   1. Carpal spasm of the hand develops when BP cuff is inflated above the systolic Pressure
3. Hyperflexia
4. Tetany
   1. Numbness, & tingling of the nose/ears/fingertips (it may progress to muscle spasm or convulsion
5. Hypomagnesium
6. Larygeal Spasm w/ Stridor
7. Arrythmias (decreased Contractility)
8. Dysphagia

1. IV Calcium Gluconate (0.5-1ml)
   1. Monitor Skin (Tissue Necrosis)
2. Diet of Ca+ Rich foods/ or Oral Supplement
3. Breath into paper bag (to control muscle spasm)
4. Monitor for Dysrhythmias
5. May need Mg
6. Seizure Precautions

1. Decrease pH Acidosis decreases ca+ binding to Albumin
2. Alkalosis increases ca+ binding to Albumin (Decrease Ionized Ca+)