Acute Hypocalcemia

by Carlo Raj, MD

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    00:02 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.

    00:37 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 so that you can restore some of that hypocalcemia.

    03:17 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 neck and back
    4. Stocking-glove over hands and feet
    5. Truncal
    1. Decreased reflexes
    2. Prolonged QT on ECG
    3. Laryngismus stridulus
    4. Hands in a forced adduction of thumb and flexion of 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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