Calcium (lab test), Hypocalcemia, Hypercalcemia
Also Consider: Mental status change
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Increased level (Hypercalcemia)
Common causes: Kidney problems, dehydration, immobilization, hyperparathyroidism
Less common causes: Lithium, thiazide diuretics, vitamin A or D intoxication, cancers, multiple myeloma, leukemia, lymphoma
Symptoms: Mental status changes, fatigue, weakness, anorexia, constipation
Decreased level (Hypocalcemia)
Common causes: Inadequate intake, Vitamin D deficiency, osteoporosis treatments, kidney problems
Less common causes: magnesium or zinc overdose, vomiting, hypoparathyroidism, pancreatitis
Symptoms: tachycardia, bruising, muscle spasms, tingling sensation around mouth and in hands and feet
1. Take Vital Signs
Temperature:
Blood Pressure:
Heart Rate:
Respiratory Rate:
Oxygen Saturation:
2. Evaluate Symptoms and Signs
Acute mental status change
Not eating or drinking as much as usual
Acute decline in ADL abilities
Signs of dehydration
Cardiovascular: Chest pain, new irregular pulse
GI: Nausea, vomiting, diarrhea, constipation, heartburn, abdominal distention or tenderness, rebound tenderness, bowel sounds
Neurologic changes: consciousness/alertness, orientation, weakness, gait changes (unsteadiness, loss of coordination or balance)
Very low urinary output (<30cc/hr)
Fingerstick glucose (patients with diabetes)
3. Take Action using SBAR Report:
Immediately notify the medical staff & resident representative
Calcium >12.5, OR
Calcium <6.1, OR
Calcium >12 or <7 WITH neurologic or GI symptoms
Notify medical staff & resident representative within the next 16 hours.
Calcium >12, or
Calcium <7
Notify medical staff on the next business day
Other Abnormal level
Notify medical staff at the next regular rounds
Normal level
SBAR Report
Situation: (High) (Low) "Calcium level of ___” (associated with:) (GI symptoms) (neurologic symptoms)
Background:
Reason the patient is in the nursing home (rehab for___, long term care for __).
Reason the test was done
When the problems started, how severe they are, getting worse or staying the same, what treatments have been used.
Abnormal Vital Signs
History of cancer, kidney problems, parathyroid disease
MOLST / Advance Directives
Recent illness, antibiotics, medication changes, surgery, falls
General observation of patient condition
Diuretic use & recent dose changes
Very low urinary output (<30cc/hr)
Blood glucose, if elevated
Abnormal findings on abdomen or neurologic observations
Availability of IV or clysis hydration (i.e., PICC line)
Assessment: I am concerned about: __________
Recommendations/Requests:
Labs: Magnesium level, Lithium level (if receiving Lithium medication), Phosphorus
Repeat BMP/Chem8, magnesium
Start or stop calcium, magnesium, or Vitamin D supplements
Stop Milk of Magnesia use
Increased salt intake
Furosemide (Lasix)
EKG
IV or SC (clysis) fluids
Increase tube feed water flushes
Change fluid restriction orders
Other:
Clarify expectations for care, interventions, and illness course/prognosis. Repeat any telephone orders back to the provider to ensure that they are correct and complete
4. Implement Management Plan
Monitor vital signs every 4-8 hrs for 2-3 days
Offer fluids frequently
Oral, IV, or subcutaneous fluids if needed for hydration
Place on Intake & Output monitoring
Monitor meal acceptance
Place on 24-hour report for 2-3 days
Obtain lab results (if ordered), and notify medical as needed of significantly abnormal values in lab tests (refer to appropriate Situation)
Implement infection control measures if indicated
Update care plan regarding fall risk, pressure ulcer prevention, assistance needed with ADLs, supervision for safety, restorative needs
Review status and plan of care with designated representative with any changes
Update advance directives if appropriate
2025-04-26
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