What are the symptoms of hypocalcemia? How is this treated?
Decreased free ionized calcium causes nervous system excitability. Symptoms include anxiety, muscle spasms, paresthesias, and seizures. Physical examination can demonstrate Chvostek’s and Trousseau’s signs. Chvostek’s sign is contraction of the facial muscles in response to tapping over the facial nerve anterior to the ear. Trousseau’s sign is elicited by occluding blood flow to the hand for 3 minutes with a blood pressure cuff. A positive sign is flexion spasm of the metacarpo-phalangeal joints. Muscle irritability can result in bronchospasm or even laryngo-spasm. The electrocardiogram shows prolongation of the QT interval.
Mild, asymptomatic hypocalcemia following para-thyroidectomy can be treated with oral calcium supple-mentation. Symptomatic hypocalcemia can present after inadvertent injury to or removal of all the parathyroid glands in a patient. When symptomatic, hypocalcemia should be treated parenterally. Typically, a solution of calcium chloride 1 mg/mL in D5W is infused at 0.5–2 mg/kg/hr. Vitamin D supplementation should be started if a calcium chloride infusion does not improve symptoms or is needed for more than a few days.