Calcium Imbalance
HYPOCALCEMIA HYPERCALCEMIA
< 9 mEq/L SIGNS AND SYMPTOMS > 11 mEq/L
Cardiovascular Cardiovascular
• ↓ HR, ↓BP, ↓ peripheral pulses • Early: Increased HR
Neuromuscular • Late: bradycardia that can cause cardiac
• Irritable skeletal muscles: Twitches, arrest
cramps, tetany, seizures • Bounding full peripheral pulses
• Painful muscle spasms in the calf or foot Respiratory
during periods of inactivity • Ineffective respiratory movement as a result
• Paresthesia’s followed by numbness that of profound skeletal muscle weakness
may affect the lips, nose, ears, and limbs Neuromuscular
• ↑ DTR • Profound muscle weakness
• Anxiety, irritability • ↓ deep tendon reflexes
Gastrointestinal • Disorientation, lethargy, coma
• ↑ motility and ↑ bowl sounds Gastrointestinal
• Abdominal cramps and diarrhea • ↓ motility
❗
Positive TROUSSEAU’S sign • ↓ bowel sounds
carpal spasm induced by inflating a BP cuff
above the systolic pressure for a few minutes
Positive CHVOSTEK’s sign
Contraction of facial muscle in response to a light
tap over the facial nerve in front of the ear EKG CHANGES
• Prolonged ST interval • Shortened ST segment
• Prolonged QT interval • Widened T wave
RISK FACTORS
• Inhibition of Ca absorption in the GI tract • Increase Ca absorption
• Increased Ca excretion • Decreased Ca excretion
o Wound drainage • Kidney disease
o Diarrhea, steatorrhea • Thiazide diuretics
o Kidney disease (diuretic phase) • Hyperparathyroidism/Hyperthyroidism
• Conditions that decrease the ionized • Malignancy (bone destruction from tumors)
fraction of Ca • Hemoconcentration
NURSING INTERVENTIONS
• Calcium supplements (PO, IV) • D/C thiazide diuretics, or IV/PO calcium
• Administer Vit D + aluminum hydroxide • EKG, and neurostatus monitoring
• Initiate seizure precautions • Loop diuretics
• Consume foods high in calcium • Encourage fluids
• Restrict dietary calcium
❗ A patient with a calcium imbalance is at risk for FRACTURES.
Move client carefully, and assist with ambulation
Foods with Calcium: cheese, milk, spinach, yogurt, tofu, sardines, greens
Calcium & Phosphate are opposites ↑Ca = ↓PO4
