Hypocalcemia and hypomagnesemia
Introduction
Introduction to hypocalcemia and hypomagnesemia When serum Ca++ is less than 2 mmol/L, it is called hypocalcemia. When serum Mg++ is lower than 0.75 mmol/L, it is called hypomagnesemia, and they often affect each other and can occur simultaneously. Generally, due to acute pancreatitis and parathyroid function damage, long-term intestinal fistula, biliary tract and other diseases lead to abnormal absorption of calcium and magnesium in the intestine, which is insufficient calcium and magnesium in the blood, resulting in hypocalcemia and hypotension. magnesium. basic knowledge The proportion of illness: 0.002% Susceptible people: no specific people Mode of infection: non-infectious Complications: arrhythmia hypermagnesemia
Cause
Causes of hypocalcemia and hypomagnesemia
Causes: Common in acute pancreatitis, damage to the function of the parathyroid glands, long-term intestinal fistula, biliary tract and so on. These diseases cause abnormal absorption of calcium and magnesium in the intestines, and insufficient calcium and magnesium in the blood, resulting in low blood calcium and low blood magnesium.
Prevention
Hypocalcemia and prevention of hypomagnesemia
1. Prevention and treatment of primary diseases, prevention or elimination of the cause of hypomagnesemia.
2. Magnesium supplementation: severe hypomagnesemia and symptoms, especially various types of arrhythmia, must be promptly supplemented with magnesium. For severe arrhythmia caused by magnesium deficiency, other therapies often have no effect, only intravenous injection or drip Magnesium salt (usually with magnesium sulfate) can be effective, intravenous magnesium should be cautious, such as patients with impaired renal function, it must be extra careful, in the magnesium supplementation process should often determine the serum magnesium concentration, must be prevented due to magnesium Too fast to become hypermagnesemia, especially in children with intravenous magnesium supplementation should also pay attention to prevent the occurrence of hypotension, because magnesium can expand the blood vessels such as peripheral arterioles, for lighter hypomagnesemia, also through the muscles The intra-injection route is supplemented with magnesium. The dosage of magnesium supplementation depends on the degree of magnesium deficiency and the severity of symptoms.
Complication
Hypocalcemia and complications of hypomagnesemia Complications arrhythmia hypermagnesemia
Common complications of this disease:
1, arrhythmia.
2. Impaired renal function.
3. Hypermagnesemia.
Symptom
Symptoms of hypocalcemia and hypomagnesemia Common symptoms Muscle beating Hypocalcemia Hypomagnesemia is prone to bilateral muscles and tremors of both hands and feet
1. Easy to be excited, anxious, awkward, muscle twitching, hand and foot.
2. The pre-ear sniper test (chrostek sign) and the upper arm compression test (Trousseau sign) were positive.
Examine
Examination of hypocalcemia and hypomagnesemia
1. Hypocalcemia and hypomagnesemia examination items: Trousseau sign, serum calcium, serum magnesium.
The Trousseau sign is the Tassen sign, which is tied to the forearm by a tourniquet or a blood pressure monitor to a systolic pressure of 20 mmHg for 3 minutes. It can also be used to force the upper arm vein to reduce the blood supply to the wrist. Positive may be alkalosis, hypomagnesemia, hypokalemia or hyperkalemia.
Trousseau sign normal: Binding the inflatable arm band is the same as measuring blood pressure. Inflate and pressurize to 2.67 kPa above the systolic pressure. Most of the requirements last for 3 minutes, and there are also requirements for up to 5min. If the foot and ankle are not induced, it is a negative reaction, indicating normal.
2. Serum calcium is less than 2mmol/L, and serum magnesium is less than 0.75mmol/L.
Diagnosis
Diagnosis and diagnosis of hypocalcemia and hypomagnesemia
Diagnose based on
1. Acute pancreatitis, damage to the parathyroid glands, long-term intestinal fistula, biliary tract and other medical history.
2. Excitable, muscle twitching, hand and foot spasm, pre-ear slamming test, upper arm compression test positive.
3. Serum calcium is lower than 2mmok/L, and serum magnesium is lower than 0.75mmok/L.
In some patients with predisposing factors and hypomagnesemia, the symptoms are difficult to distinguish from hypokalemia. If there is still no improvement after potassium supplementation, hypomagnesemia should be considered. In addition, it may occur. and suspected that patients with calcium deficiency, after injection of calcium, can not relieve sputum, should also be suspected of magnesium deficiency, it must be combined with clinical history analysis, if necessary, can be used for magnesium load test, to determine magnesium deficiency The diagnosis is of great help. In normal people, after intravenous infusion of magnesium chloride or magnesium sulfate 0.25mmol/kg, 90% of the injected amount is quickly discharged from the urine, while in patients with hypomagnesemia, the same amount of solution is injected. 40% to 80% of the input magnesium can be retained in the body, and even only 0.5mmol of magnesium is excreted from the urine every day. The magnesium load test method is as follows. Collect all the urine of the patient within 24 hours before the test, and then inject sulfuric acid from the vein. Magnesium or magnesium chloride solution 0.25mmol / Kg, and then collect all the urine within 24h after instillation, the magnesium content of the two urine before and after the determination, and compared with the intravenous delivery.
