Immediate Questions

A. Is patient symptomatic? Hypocalcemia can be asymptomatic or associated with serious life-threatening manifestations. Severe manifestations that require immediate treatment include paresthesias, tetany, laryngospasm, and seizures. Diagnostic signs suggesting the need for immediate treatment are positive Chvostek and Trousseau signs.

B. Is low serum calcium level an artifact or reflective of low ionized calcium? Whereas total serum calcium is routinely measured, it is the ionized calcium component that is physiologically important. Ionized calcium can be measured directly or can be estimated by subtracting 0.8 mg/dL for every 1 g/dL by which serum albumin is < 4 g/dL.

C. Is serum magnesium level low? Serum calcium will not respond to correction with IV or oral calcium as long as severe hypomag-nesemia remains untreated.

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