Hypocalcaemia

Question 1

What are the symptoms of hypocalcaemia?

Answer 1

Pins and needles 
Lethargy 
Numbness
Spasm 
Aches + pains 
Laryngospasm - stridor

Question 2

What is Trousseau’s sign?

Answer 2

Carpo-pedal spasm when brachial artery occluded by BP cuff

Question 3

What is Chvostek’s sign?

Answer 3

Tapping over parotid causes facial muscles to twitch

Question 4

What are the ECG changed in hypocalcaemia?

Answer 4

Increased QT interval

Question 5

What can cause hypocalcaemia?

Answer 5

Iatrogenic - thyroidectomy 
Autoimmune 
Infiltration - sarcoidosis, TB
Vitamin D deficiency 
Renal failure 
Psuedohypoparathyroidism 
Multiple blood transfusions 
Low magnesium

Question 6

How does renal failure cause hypocalcaemia?

Answer 6

Kidneys activate vitamin D
Vitamin D helps absorption of calcium

Kidney failure reduces activation of vitamin D

Question 7

How do multiple blood transfusions cause hypocalcaemia?

Answer 7

Citrate in blood to prevent clots

Citrate reduces calcium levels

Question 8

How does low Mg cause hypocalcaemia?

Answer 8

Mg regulates PTH

Question 9

What is pseudohypoparathyroidism?

Answer 9

Rare genetic disorder with resistance to PTH

Low calcium
Normal/high phosphate
Normal PTH

Question 10

What are signs of pseudohypoparathyroidism?

Answer 10

Short 4th metacarpal
Short stature
Round face
Mental retardation

Question 11

How is mild hypocalcaemia managed?

Answer 11

Sandocal / Adcal D3

Question 12

How is severe hypocalcaemia managed?

Answer 12

10mls of 10% calcium gluconate in 100mls dextrose/saline over 10 mins

Repeat until asymptomatic