Juan D
Arch Intern Med. 1979 Oct;139(10):1166-71. doi: 10.1001/archinte.139.10.1166.
There is much individual variability in the clinical manifestations of hypocalcemia. The rapidly of the development of hypocalcemia will determine whether or not symptoms will be present. Signs and symptoms of hypocalcemia consisted of tetany (Chvostek's and Trousseau's signs), seizures, diminshed to absent deep tendon reflexes, papilledema, mental changes (weakness, fatigue, irritability, memory loss, confusion, delusion, hallucination), and skin changes. Etiologic factors for hypocalcemia in man include (1) decreased calcium absorption or increased loss from the gastrointestinal tract; (2) parathyroid hormone deficiency; (3) skeletal resistance to parathyroid hormone; (4) ineffective parathyroid hormone; (5) decreased production or increased degradation of 25-hydroxycholecalciferol or 1,25-dihydroxycholecalciferol; (6) increased complex formation with calcium; (7) increased skeletal uptake of calcium; (8) hypomagnesemic state; and (9) direct inhibition of bone resorption. Measurement of total and ionic calcium, magnesium, parathyroid hormone, vitamin D metabolites (25-hydroxycholecalciferol, 1,25-dihydroxycholecalciferol), and nephrogenous cyclic adenosine monophosphate are especially helpful in the laboratory evaluation of the hypocalcemic patient.
低钙血症的临床表现存在很大的个体差异。低钙血症发展的速度将决定是否会出现症状。低钙血症的体征和症状包括手足搐搦（Chvostek征和Trousseau征）、癫痫发作、腱反射减弱或消失、视乳头水肿、精神改变（虚弱、疲劳、易怒、记忆力减退、意识模糊、妄想、幻觉）以及皮肤改变。人类低钙血症的病因包括：（1）胃肠道钙吸收减少或丢失增加；（2）甲状旁腺激素缺乏；（3）骨骼对甲状旁腺激素抵抗；（4）甲状旁腺激素作用无效；（5）25-羟胆钙化醇或1,25-二羟胆钙化醇生成减少或降解增加；（6）钙复合物形成增加；（7）骨骼对钙摄取增加；（8）低镁血症状态；（9）直接抑制骨吸收。测定总钙和离子钙、镁、甲状旁腺激素、维生素D代谢产物（25-羟胆钙化醇、1,25-二羟胆钙化醇）以及肾源性环磷酸腺苷，对低钙血症患者的实验室评估特别有帮助。
