Acute Hypocalcemia: Presentation… you’ll
have your tetany, extreme irritated-irritability.
We talked about paresthesia, especially
perioral-oral, when we talked about it in
carpopedal spasms, also Chvostek’s sign.
In the motor issue, we have stiffness and
clumsiness, myalgia, muscle spasm and cramps…
Hands may show forced adduction of the thumb,
flexion of the metacarpophalangeal joint and
wrists and extension of the fingers.
So, kind of looks like this that I’m showing
you, this is due to hypocalcemia.
The spasms of respiratory muscle and of the
glottis so then refer-referred to as being
your laryngismus or stridulus can cause cyanosis.
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.
There might be prolonged QT syndrome or read
about prolonged QT interval resulting in long
And once again, not only would you have spasms
in the skeletal muscle, cardiac muscle, but
then also pulmonary may result in bronchospasm.
As I told you earlier, there might be difficulty
with breathing and so, therefore, may result
in bronchospasms and sinuses.
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
This, on your left, is positive Chvostek’s
sign; on the right, it’s recovery from the
There’s something called Trousseau’s sign
exactly as to what we talked about earlier.
A flexion of the wrist, flexion of metacarpophalangeal
and extension of the fingers just a little
We call this Trousseau’s sign.
Carpopedal spams elicited by placing a blood
pressure cuff around your arm resulting in
Trousseau’s sign or carpopedal spasms.
Do not forget about the circumoral numbness
that may also be associated with your hypocalcemia.
Evaluation, diagnosis, clinical presentation.
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.
PTH maybe perhaps decreased and Vitamin D
Important, important laboratory values that
you want to keep in mind so that you are able
to steer your diagnosis in the correct direction.
Severe hypocalcemia in symptomatic patients
treated with slowly administered IV calcium
gluconate or calcium chloride.
You pay attention to calcium gluconate.
Mild cases are treated with oral calcium carbonate
or calcium citrate usually in conjunction
with Vitamin D so that you can restore some
of that hypocalcemia.
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.