Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at September 6, 2016

Hypocalcaemia or hypocalcemia is a condition in which there are abnormally low levels of calcium in the blood, and it is mostly caused by hypoalbuminemia.


Definition & Facts

Hypocalcaemia is an imbalance of electrolytes involving low levels of calcium in the blood. Normal calcium levels in an adult can range between 4.5 and 5.5 mEq/L. Doctors often test for hypocalcaemia by checking blood albumin levels. Half of all patients in intensive care units have hypocalcaemia.

Calcium plays an important role in the functioning of the nerves and muscles. In addition, the electrolyte plays an important role in teeth and bone health. Calcium is also an important requirement in the healthy functioning of the kidneys, intestines, and parathyroid hormone.

Symptoms & Complaints

Muscle spasms and twitching are some of the most common symptoms of hypocalcaemia. These may be accompanied by numbness and tingling in the legs, feet, hands or arms.

Congestive heart failure and hypotension are also symptoms of hypocalcaemia. Dermatitis and cataracts are additional symptoms. People with hypocalcaemia may also have cardiac arrhythmias.

Dementia, seizures, depression, and anxiety are symptoms that can arise from hypocalcaemia.


Hypoparathyroidism is one of the most common causes of hypocalcaemia. It is a type of endocrine disease characterized by low amounts of parathyroid hormone. It may be caused by accidental trauma or removal of the parathyroid glands (which consists of four glands) as treatment for head and neck cancer including laryngeal cancer. Hypoparathyroidism can also result from radiation therapy for cancers. Autoimmune diseases can trigger hypoparathyroidism by activating the immune system to attack the tissues of the parathyroid glands.

Hypermagnesemia, which is commonly triggered by acute kidney failure can also cause hypocalcaemia. Kidney disease – including acute forms and chronic kidney failure – is thus a cause of hypocalcaemia. Chemotherapy, sepsis, pancreatitis are additional causes of hypocalcaemia.

Vitamin D deficiency has also been associated with hypocalcaemia. Vitamin D is stored in the fat and liver. Vitamin D deficiency can result from inadequate exposure to sunlight. People who spend most of their time indoors are susceptible to vitamin D deficiency. Vitamin D deficiency is a common occurrence during the winter months, especially among the elderly.

Vitamin D deficiency can also result from obesity and inadequate dietary intake. Chronic liver disease can also cause vitamin D deficiency. Celiac surgery and inflammatory bowel disease may also contribute to vitamin D deficiency.

Diagnosis & Tests

Diagnosing hypocalcaemia involves running blood tests in addition to standard diagnostic procedures such as taking a medical history and family history and performing a physical examination. A diagnosis of reduced levels of ionized calcium can be determined by a blood test. An ionized calcium level lower than 4.4 mg is considered hypocalcaemia.

To determine whether or not the patient has a number of causal factors such as pancreatitis, kidney failure, and hypermagnesemia, the health care professional will test the blood for creatinine. magnesium, and amylase among other substances.

Tests like serum 25 hydroxyvitamin D concentration help to determine vitamin D deficiency. Blood tests will also assess whether or not the individual has low levels of parathyroid hormone.

Treatment & Therapy

Hypocalcaemia can often resolve on its own once the primary cause of it has been addressed. Nevertheless, intravenous calcium is a therapy that is often used to treat hypocalcaemia and restore electrolyte balance to the body. Oral supplements of calcium and vitamin D supplements may be recommended if a patient is not facing a medical emergency upon seeking care.

Treatment will address underlying causes as well as complications of the disease. Hemodialysis may be necessary if the patient suffers from kidney disease. This involves a machine that filters blood in a person's body, performing the function of the kidneys. Hormone replacement therapy may also be recommended to replace parathyroid hormone.

Psychiatric problems caused by hypocalcaemia may be addressed through the use of psychiatric medications and psychotherapy (talk therapy). Types of psychotherapy include cognitive behavior therapy. Psychiatric medications include anxiolytics which combat anxiety and antidepressants, of which selective serotonin reuptake inhibitors is one category.

Prevention & Prophylaxis

Preventing hypocalcaemia can be difficult because it often is the result of necessary treatments for other ailments. The largest contributing factor to hypocalcaemia is hypoparathyroidism which is most often caused by surgery and cancer treatment.

Quitting smoking and avoiding secondhand smoke as well as drinking in moderation or abstaining from alcohol and illicit drug use will improve one's overall health and make underlying causes of hypocalcaemia less likely.