It's official everybody, cocky calcium, that jerk, is going on an all-inclusive vacation to Mexico! Baja California, that low calcium, get it? See?
California? Low calcium? Get it?
You can see him chilling by the pool, forgetting his job duties and learning a few new dance moves. Like trusos, which is basically that arm twerk when you put a blood pressure cuff on. He'll also learn Vostok's sign, which is that smile when you touch the side of the face. Kind of like this. And he'll also have massive diarrhea.
But more on this in a minute. Today we're wrapping up hypocalcemia. Hypo meaning low, cal meaning calcium, and emia in the blood.
So calcium less than 9.0 in the blood. Calcium is regulated by three main hormones. First, the parathyroid hormone, which increases calcium concentration inside the blood. Next is calcitonin hormone, which decreases blood calcium and puts a ton of calcium into the bone. Third is calcitrol, which controls blood calcium by inhibiting the release of calcitonin.
Basically, it reverses that ton of calcium in the bone, so calcium gets released into the bloodstream. Now, here's a little fun fact about calcium. His BFF, his best friend forever, is Magnum Magnesium.
So calcium helps fill job functions for magnesium, often when magnesium is low. His worst enemy is friendly frat boy phosphate. So you'll often see when phosphate is low, calcium is high, and when calcium is low, phosphate's high.
Now calcium is a strong guy, and so his function is to keep the three B's strong. So strong bones, blood, and beats. For blood, the clotting factors will be strong, and beats, we're talking about heartbeats. Now, the main causes that dump calcium out of the body and into the body, we use the acronym LOCALI, because it's like, low California, get it?
C-A, California. So, the L stands for low parathyroidism. Now, since PTH, that parathyroid hormone, increases blood calcium levels, well then guys, decreased PTH secretion, Well, decrease that blood calcium levels. So if your patient has a history of surgeries like a thyroidectomy, well then you want to check the calcium levels like always. Pancreatitis is an inflammation inside the abdominal cavity usually from infections, but it also causes low calcium primarily from the release of calcium soaps inside the abdominal cavity.
And it stimulates calcitonin hormone to put all that calcitonin from the blood in and into the bone. O is for oral meds that deplete calcium, like laxatives and loop diuretics like furosemide. But also, corticosteroids in large doses or prolonged use can cause a reaction to suppress that PTH, parathyroid hormone, and it suppresses calcium release in the blood. Anti-seizure medications like Dilantin, which is a phenobarbital, promote excretion of calcium release.
by the kidneys. And our last two, phosphate enemas, which increase phosphate and decrease calcium. Remember they're like arch enemies?
And finally, citrate is an anticoagulant used in blood products. It is usually rapidly metabolized by the liver right here, but guys with liver damage or rapid administration of let's say stored blood products, it may cause hypocalcemia and low magnesium because citrate binds to calcium and magnesium in the blood. So remember, magnesium and calcium are BFFs, best friends forever. So they kind of follow each other around wherever they go. W is for wound drain, especially in the GI system where calcium is normally absorbed.
And the next is kind of the same here, because C, chronic diseases like celiac disease and Crohn's disease, diseases of the bowel, cause malabsorption of calcium in the GI tract. C can also stand for chronic kidney issues. like excessive excretion of calcium by the kidneys or even diuretics that cause excretion of calcium through diuresis. Basically peeing it out. A is for antibiotics.
Now, some antibiotics can push calcium into the cell and decrease those serum blood levels of calcium. L is for low vitamin D or low magnesium levels, which can lead to hypocalcemia. Because remember, they help each other absorb in the body. So once again, I've said it before but I'll say it again, magnesium and calcium are best buds and they love vitamin D together. People let me tell you about my best friend, he's a warm hearted...
I is for increased phosphate levels in the blood because remember, phosphate and calcium are arch enemies and do the opposite of each other. So if one is high, well then the other one is low. So what's going on in hypocalcemia?
Well low, low calcium, right? And since cocky calcium has gone to Mexico, Baja California, well then everything on the body is on vacation. So when you're on vacation, you usually forget about your job duties.
So you think there are going to be strong bones? Well no guys, there's going to be weak, so we'll have fractures. You think there'll be strong clotting factors? Not at all, it'll be weak, so big risk for bleeding. You think there'll be strong heartbeats?
No, there's gonna be dysrhythmias. You guys, he's in Mexico, he's excited, he forgot about his jobs. In the heart you'll have excitability, so ventricular tachycardia, a very deadly rhythm that can be shocked. Now before it gets to V-tach, the EKG might have prolonged QT intervals and ST segments, as well as slow clotting factors, so a huge risk for bleeding and even heart failure.
So the lungs will be excited, you'll have laryngospasms, which causes a stridor. It's basically a narrowing of the windpipe, which causes a harsh, high-pitched noise when breathing. Now it's rare in adults, but it's very serious, because it's an airway problem. Difficulty breathing called dyspnea, and even crackles, when heart failure is present.
GI will be excited, so you'll have massive diarrhea, as well as intestinal cramping. So neurologically, you'll have excitability, so seizures, confusion, even. personality changes and may even exhibit signs of dementia or even psychosis. Musculoskeletal, the biggest two indicators of low calcium are our two famous dance moves.
First we have trousseau's which is our tambourine dance move, basically that arm twerk with the blood pressure cuff on. Next is chavostics which is that cheesy smile when touching the temporal lobe area, like this. Alright, now that we know what's wrong with the patient, what are we going to do about it?
Here's some nursing interventions for hypocalcemia. And honestly, it's a simple fix. We're just going to add some calcium.
So we use our acronym FAST for nursing interventions. So foods high in calcium. We use the acronym LSD. L for leafy greens like spinach, colored greens, and rhubarb.
S is for sardines and tofu. And D is for dairy like cheeses, milk, and yogurt. A is for administration of meds like calcium acetate, now the trade name being Foslo. We'll give IV calcium and oral calcium with vitamin D supplements to make sure they absorb. Now doctors may order calcium containing antiacids like Tums or even Maalox, also called Mylanta.
Generic name for aluminum hydroxide or magnesium hydroxide. Because please remember the NCLEX is only going to ask you these generic names, no more trade names. Now these are given to increase magnesium in hopes that calcium will increase too because let's be honest, they're best friends. Oh my lanta. S is for safety, so the risk for falls, fractures, and bleeding.
Because guys remember the three B's, calcium is responsible, we want to protect and make strong. So for weak bones we have fracture precautions, so guys watch out for falls. Weak blood you have a low clotting factor, so big risk for bleeding.
So educate your patients to be careful when shaving, as well as not to bear down when pooping, as well as not to brush too hard when brushing their teeth. Now the last one is weak beats, so watch out for cardiac dysrhythmias. T is for teach, so take calcium booster supplements like magnesium supplements and vitamin D and avoid calcium depleters like laxatives and loop diuretics. Alright guys, that wraps up low calcium, that hypocalcemia. Thanks for watching.
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