Acute Hypocalcemia

by Carlo Raj, MD

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    00:01 Acute Hypocalcemia: Presentation… you’ll have your tetany, extreme irritated-irritability.

    00:06 We talked about paresthesia, especially perioral-oral, when we talked about it in carpopedal spasms, also Chvostek’s sign.

    00:13 In the motor issue, we have stiffness and clumsiness, myalgia, muscle spasm and cramps… myalgia.

    00:21 Hands may show forced adduction of the thumb, flexion of the metacarpophalangeal joint and wrists and extension of the fingers.

    00:29 So, kind of looks like this that I’m showing you, this is due to hypocalcemia.

    00:36 The spasms of respiratory muscle and of the glottis so then refer-referred to as being your laryngismus or stridulus can cause cyanosis.

    00:50 Continuing the tetany and the irritability, cardiovascular, hypotension, decreased cardiac contractility because of extreme twitching not only skeletal muscles, but perhaps even in the heart.

    01:01 There might be prolonged QT syndrome or read about prolonged QT interval resulting in long QT syndrome.

    01:08 And once again, not only would you have spasms in the skeletal muscle, cardiac muscle, but then also pulmonary may result in bronchospasm.

    01:17 As I told you earlier, there might be difficulty with breathing and so, therefore, may result in bronchospasms and sinuses.

    01:25 What we see here is a patient on your left who, upon tapping of the facial nerve, resulted in twitching of the eyes, the nose and the mouth.

    01:39 This, on your left, is positive Chvostek’s sign; on the right, it’s recovery from the tetany.

    01:47 There’s something called Trousseau’s sign exactly as to what we talked about earlier.

    01:52 A flexion of the wrist, flexion of metacarpophalangeal and extension of the fingers just a little bit.

    01:59 We call this Trousseau’s sign.

    02:01 Carpopedal spams elicited by placing a blood pressure cuff around your arm resulting in Trousseau’s sign or carpopedal spasms.

    02:12 Do not forget about the circumoral numbness that may also be associated with your hypocalcemia.

    02:19 Evaluation, diagnosis, clinical presentation.

    02:24 Post neck surgery, just in case the surgery then reveals to you, “Oh, yeah, it might be hypocalcemia maybe because of surgery”; decreased calcium, increased phosphate; magnesium will be altered.

    02:38 PTH maybe perhaps decreased and Vitamin D perhaps decreased.

    02:42 Important, important laboratory values that you want to keep in mind so that you are able to steer your diagnosis in the correct direction.

    02:54 Severe hypocalcemia in symptomatic patients treated with slowly administered IV calcium gluconate or calcium chloride.

    03:04 You pay attention to calcium gluconate.

    03:06 Mild cases are treated with oral calcium carbonate or calcium citrate usually in conjunction with Vitamin D.

    03:13 Hypoparathyroid patients require activated Vitamin D calcitriol because without that PTH, there’s absolutely no way that the 1-alpha-hydroxylase will be activated, thus rendering your patient Vitamin D deficient.

    About the Lecture

    The lecture Acute Hypocalcemia by Carlo Raj, MD is from the course Parathyroid Gland Disorders.

    Included Quiz Questions

    1. Perioral
    2. Periorbital
    3. Cape-like over the neck and back
    4. Stocking glove distribution (over the hands and feet)
    5. Truncal
    1. Decreased reflexes
    2. Prolonged QT on ECG
    3. Laryngismus stridulous
    4. Hands in forced adduction of thumb and flexion of the wrist
    5. Trousseau's sign
    1. IV or oral calcium with calcitriol
    2. IV or oral calcium with PTH
    3. IV or oral vitamin D with PTH
    4. IV or oral calcium with inactive vitamin D
    5. IV calcium only

    Author of lecture Acute Hypocalcemia

     Carlo Raj, MD

    Carlo Raj, MD

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