PANCE - Hypocalcemia Management

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Here are key facts for PANCE 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 PANCE

Clinical Presentation and Definition

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

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

3. Symptomatology: Muscle spasms, tingling, lethargy, seizures, and QT interval prolongation

Etiology

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

Clinical Management

1. Acute intervention: IV bolus 1-2 g calcium gluconate followed by 1000 ml infusion of 1 mg/ml elemental calcium at 50mg/hr 2. Chronic management: Oral calcium supplementation at 1-2 g of calcium gluconate daily in divided doses 3. Monitoring protocols: Daily calcium levels for acute cases, weekly monitoring for chronic cases

HIGH YIELD

Treatment Selection Guidelines

1. Severity-based approach: Route determined by calcium level (IV for ≤7.5 mg/dL, oral for >7.5 mg/dL) 2. Transition of care: Switch to oral calcium after stabilization with IV therapy 3. Special populations: Initiate calcitriol with oral calcium for hypoparathyroidism

Clinical Pearls

1. Associated imbalances: Correct hypomagnesemia when present 2. Administration technique: Divide oral calcium doses for better absorption 3. Emergency indicators: Seizures and pronounced QT prolongation require immediate IV calcium

Diagnostic Approach

1. Initial workup: Serum calcium measurement when symptoms suggest hypocalcemia 2. Risk assessment: Higher vigilance in patients with known hypoparathyroidism, vitamin D deficiency, or CKD 3. ECG correlation: Monitor for resolution of QT prolongation with treatment

Beyond the Tutorial

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

Differential Diagnosis

1. Neuromuscular mimics: Distinguish from hypomagnesemia, tetanus, and strychnine poisoning 2. Seizure disorders: Rule out other causes of seizure activity 3. Cardiac presentations: Differentiate from other causes of QT prolongation

Advanced Assessment

1. Corrected calcium: Calculate adjusted calcium in hypoalbuminemia 2. Parathyroid function: Interpret PTH levels in relation to calcium status 3. Vitamin D status: Evaluate 25-OH and 1,25-OH vitamin D levels

Preventive Strategies

1. Post-surgical monitoring: Protocols after thyroidectomy or parathyroid surgery 2. Medication review: Identify drugs that may induce hypocalcemia 3. Renal disease management: Calcium monitoring in progressive CKD

Patient Communication

1. Medication adherence: Strategies to improve compliance with daily supplementation 2. Follow-up importance: Emphasizing the need for regular monitoring 3. Symptom recognition: Teaching patients to identify early signs of recurrence