Hypomagnesemia clinical presentation

The clinical manifestations of hypocalcemia are quite variable. The acuteness of the development of hypocalcemia plays a large role in whether or not symptoms will occur." The more acute the drop in ionized calcium concentration, the more likely the patient will develop symptoms. Thus acid-base balance plays a significant role in the hkeiihood of the development of hypocalcemic symptoms, with alkalosis predisposing to symptom development. Concomitant hypomagnesemia, hypokalemia, hyponatremia, and additive side effects from prescribed medications also increase the likelihood of symptomatic presentation. 

B. Specific drugs and antidotes. When clinically significant hypocalcemia is present, administer intravenous calcium gluconate (see p 424), 10-20 mL (children 0.2-0.3 mL/kg), and monitor ionized calcium levels and titrate further doses as needed. Treat hypomagnesemia with intravenous magnesium sulfate, 1-2 g given over 10-15 min (children 25-50 mg/kg diluted to less than 10 mg/mL). Treat hyperkalemia with intravenous calcium and other usual measures (p 37). 

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