Acute hypocalcemia

Q: All of the following are the signs of acute hypocalcemia EXCEPT? (select one)

A) tetany

B) papilledema

C) seizures 

D) basal ganglia calcification

Answer: D

Patients with hypoparathyroidism usually develop signs of chronicity like ectodermal and dental changes, cataracts, basal ganglia calcification, and extrapyramidal disorders. All these signs take years to develop.

In contrast, people who develop acute hypocalcemia have:

Tetany — It occurs due to increased peripheral neuromuscular irritability with perioral numbness, paresthesias of the hands and feet, muscle cramps, carpopedal spasms, and laryngospasms. The classic physical signs are Trousseau's and Chvostek's signs.

Seizures — One of the interesting seizure findings on EEG in patients with acute hypocalcemia is both spikes ("convulsive effect") and bursts of high-voltage, paroxysmal slow waves.

Cardiovascular — Acute myocardial dysfunction is common. Clinicians should watch for prolongation of the QT interval on EKG, because it may lead to Torsades de pointes.

Papilledema — The presence of papilledema means hypocalcemia is severe.

Psychiatric — Emotional instability, anxiety, and depression are common, but severe acute hypocalcemia may cause confusional states, hallucinations, and frank psychosis.

Fortunately, most signs and symptoms of acute hypocalcemia are reversible with repletion.

#electrolytes

References:

1. Bove-Fenderson E, Mannstadt M. Hypocalcemic disorders. Best Pract Res Clin Endocrinol Metab. 2018 Oct;32(5):639-656. doi: 10.1016/j.beem.2018.05.006. Epub 2018 May 28. PMID: 30449546.

2. Schafer AL, Shoback DM. Hypocalcemia: Diagnosis and Treatment. [Updated 2016 Jan 3]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279022/

3. Pepe J, Colangelo L, Biamonte F, Sonato C, Danese VC, Cecchetti V, Occhiuto M, Piazzolla V, De Martino V, Ferrone F, Minisola S, Cipriani C. Diagnosis and management of hypocalcemia. Endocrine. 2020 Sep;69(3):485-495. doi: 10.1007/s12020-020-02324-2. Epub 2020 May 4. PMID: 32367335.