Lab Case 157 – interpretation

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A 34 year old with 3 renal transplants and parathyroidectomy presents after a seizure.

Causes for seizure include1. Go through seizure sieve in systematic way

head trauma, stroke, brain tumors, alcohol or drug withdrawal, repeated episodes of metabolic insults, such as hypoglycaemia, severe electrolyte disorders, hypoxia, genetic disorders etc etc.

  1. Severe hypocalcaemia

mild hypokalaemia

acute on chronic renal failure

mild metabolic acidosis

probable low Mg

chronic anaemia due to renal failure

  1. ECG changes include u waves, QTc changes (prolongation), risk of torsade

Her ECG is attached

  1. replace Ca, K, Mg

Supportive treatment (ABC approach ie, IV fluid replacement, oxygen, monitoring) often is required prior to directed treatment of hypocalcaemia.

IV replacement is recommended in symptomatic or severe hypocalcemia with cardiac arrhythmias or tetany. Doses of 100-300 mg of elemental calcium (10 mL of calcium gluconate contains 90 mg elemental calcium; 10 mL of calcium chloride contains 272 mg elemental calcium) in 50-100 mL of 5% dextrose in water (D5W) should be given over 5-10 minutes. This dosage raises the ionized level to 0.5-1.5 mmol and should last 1-2 hours. Caution should be used when giving calcium chloride intravenously.

Calcium chloride 10% solution delivers higher amounts of calcium and is advantageous when rapid correction is needed, but it should be administered via central venous access. Calcium infusion drips should be started at 0.5 mg/kg/hr and increased to 2 mg/kg/hr as needed, with an arterial line placed for frequent measurement of ionized calcium.

TF to renal unit