ABIM - Hypocalcemia Management

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Here are key facts for ABIM from the Hypocalcemia Management tutorial, as well as points of interest at the end of this document that are not directly addressed in this tutorial but should help you prepare for the boards. See the tutorial notes for further details and relevant links.

VITAL FOR ABIM

Diagnostic Criteria

1. Laboratory definition: Serum Ca < 8.5 mg/dL 2. Clinical stratification:

Chronic/Mildly Symptomatic: Ca > 7.5 mg/dL
Acute/Symptomatic: Ca ≤ 7.5 mg/dL

Clinical Manifestations

1. Neuromuscular symptoms: Muscle spasms, tingling, lethargy, seizures 2. Cardiovascular findings: QT interval prolongation

Etiologic Considerations

1. Common causes: Hypoparathyroidism, vitamin D deficiency and chronic kidney disease

Management Principles

1. Acute treatment protocol: IV bolus 1-2 g calcium gluconate followed by 1000 ml infusion of 1 mg/ml elemental calcium at 50mg/hr 2. Chronic treatment approach: Oral calcium supplementation at 1-2 g calcium gluconate daily in divided doses

HIGH YIELD

Monitoring Parameters

1. Acute cases: Measure serum calcium levels daily 2. Chronic cases: Monitor serum calcium weekly 3. Treatment transition: Switch to oral calcium post-stabilization of acute cases

Special Management Considerations

1. Hypoparathyroidism: Initiate calcitriol with oral calcium 2. Concurrent electrolyte abnormalities: Correct hypomagnesemia

Therapeutic Decision Making

1. Route selection: IV for acute/symptomatic (Ca ≤ 7.5 mg/dL), oral for chronic/mild (Ca > 7.5 mg/dL) 2. Dosing strategy: Divided doses for oral supplementation to optimize absorption 3. Duration of therapy: Continuous infusion until stabilization, then transition to oral maintenance

Beyond the Tutorial

Below is information not explicitly contained within the tutorial but important for ABIM.

Pathophysiologic Mechanisms

1. Calcium homeostasis: Role of PTH, vitamin D, and calcium-sensing receptors 2. Ionized vs. total calcium: Interpretation in various clinical contexts 3. Electrocardiographic changes: Mechanism of QT prolongation in hypocalcemia

Evidence-Based Management

1. Acute intervention trials: Efficacy of different calcium salt preparations 2. Long-term management studies: Outcomes with various vitamin D analogs 3. Guidelines: KDIGO recommendations for CKD-related hypocalcemia

Complications and Prognosis

1. Treatment complications: Hypercalcemia from overzealous correction 2. Long-term sequelae: Risk of soft tissue calcification with chronic therapy 3. Quality of life impact: Neuropsychiatric manifestations of chronic hypocalcemia

Complex Case Management

1. Refractory hypocalcemia: Approach to cases unresponsive to conventional therapy 2. Critically ill patients: Modifications in management for ICU setting 3. Endocrine consultation: Indications for specialist referral in complicated cases