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.