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''Sx'' - numbness, paraesthesia, muscle cramps, convulsions, cataracts,
parkinsonism (basal ganglia calcification) trousseaus (compress upper
arm and hand spasm) and chvostek's sign, papilloedema

''Ix''
PO3, alk phos, Cr, Mg, vit D and PTH levels need checking if low Ca (check if put in wrong tube - EDTA ...)
Note - HypoCa gives long QT interval on ECG

''Causes''
//Vitamin D deficiency// - little sun, diet (beware chapati - high phytate binds Ca preventing absorption), malabsorption, //renal failure//, anticonvulsants
PTH deficiency - hypoparathryriod, hypoMg, parathroidectomy
PTH resistance - hypoMg, pseudohypoparathryoid
artefactual - if put in EDTA tube
Other - pancreatitis, high PO3 intake, rhabdomyolysis, hungry bone syndrome

''Vitamin D deficiency''
low Ca PO3 and high alk phos (but may all be normal)
raised PTH (attempting to raise Ca)
Carbamazepine clears vit D more quickly as potentiates hepatic enzymes
Vit D - mostly from UVB on dermis (less effective if pigmented skin),
diet - oily fish, egg yolk (insufficient for full requirement)
measure 25OHD - >50 OK, 30-50 ?? <30 deficient
treat with oral vitD3 - load then maintain, daily or intermittently

''Coeliac'' - think with other autoimmune
low Ca from malabsorption leading to rickets / osteomalaccia

''Osteomalaccia'' - raised alk phos, hypoCa, hypo PO3