Out of the entire calcium amount found in one’s organism, only 0.1% is found in body liquids. In order to transfer calcium throughout the body, bones, intestines, kidneys as well as parathyroid hormone play an important role. Hypocalcaemia is the first phase of hungry bone syndrome (also referred to as HBS), which happens when the level of ionized calcium in blood falls under 1.0 mmol/L. Causes for this to happen can be chronic exhaustion of kidneys, hypo parathyroid (reduced excretion of parathyroid hormones), septic shock, lack of vitamin D and many others. Apart from hypocalcaemia, hypophosphatemia and hypomagnesaemia play an important role in developing this condition as these are closely associated with HBS. Let’s take a closer look at some of the details related to this condition.
How does HBS manifest?
Signs of HBS highly depend on the intensity and volume of calcium level drop over time. Clinical symptoms are notices when the level of calcium drops below 1.7 mmol/L. Basic symptoms are neurological and the patient feels numbness in extremities and around lips. Muscle spasms are also commonly showing, such as cases when the muscle cramps up on slightly stronger contact – this is easily discovered on facial muscles, where the patient’s muscles will cramp up after a gentle slap. An advanced phase can include whole body cramping up in a certain position, which can lead towards laryngospasm and respiratory arrest, which makes HBS an extremely perilous condition. Contraction of the smooth musculature can also cause cramps of organs found in the stomach cavity as well as strong urges for urination. Mental disorders manifest as irritability, depression, psychosis and dementia. The before mentioned hypocalcaemia can also lead toward heart failure and a disordered function of beta adrenergic.
Diagnosis and treatment
Diagnosis is established based on anamnesis, physical checkups of the patient and laboratory tests. In a differential diagnosis age of the patient plays an important role, as well as phosphataemia (measuring the level of phosphates in blood), general health of the patient and stage of the disease. Hypophosphatemia indicates weakness of the kidneys or hypo parathyroid issues. These are some of the alternative methods of diagnosis, since the disease becomes quite apparent with muscle spasms and cramps, particularly if the patient ignored some of these symptoms.
Treatment of patients with symptoms of HBS or advanced stages of hypocalcaemia needs to be urgent. Usually, calcium gluconate is administered intravenously over periods of ten minutes. In order to accomplish the desired effect, particularly with advanced stages of hypocalcaemia, vitamin D is to be administered as well since it plays an important role in retarding the condition. During the therapy it is necessary to keep a close eye on levels of calcium, magnesium and potassium in the blood stream. Patients who are going under this treatment are also to be provided with proper EKG monitoring. This helps to prevent cardio toxicity and with correction of potassium levels, functional and histological recovery of kidneys these symptoms are to disappear within two months.