Calcium (Ca2+) on the NCLEX
Hypocalcemia (Chvostek, Trousseau) and hypercalcemia: causes, treatment.
Calcium 8.5-10.5 (total) or 4.5-5.5 (ionized). NCLEX hammers Chvostek and Trousseau signs.
Hypocalcemia (<8.5)
Causes: hypoparathyroidism, vitamin D deficiency, pancreatitis, CKD, large transfusion (citrate binds Ca). Signs: Chvostek (facial twitch), Trousseau (carpal spasm with BP cuff), tetany, paresthesias, seizures, prolonged QT. Treatment: calcium gluconate IV (severe), calcium carbonate or citrate PO. Vitamin D.
Hypercalcemia (>10.5)
Causes: hyperparathyroidism, malignancy (most common in inpatients), immobility, thiazides, vitamin D toxicity. Signs: 'bones, stones, groans, psychic moans', bone pain, kidney stones, abdominal pain, depression/confusion. Short QT. Treatment: IV NS + furosemide. Bisphosphonates. Calcitonin acute. Treat underlying.
Frequently asked
Albumin and calcium?
Total calcium adjusts with albumin. Ionized calcium is the active form, check it if albumin abnormal.
Tums and hypocalcemia?
Calcium carbonate. Can supplement chronically. Watch for hypercalcemia and constipation.
Quick check
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