From the Guidelines
Hypocalcemia is characterized by several recognizable signs on physical examination, including Chvostek's sign and Trousseau's sign, which are indicative of neuromuscular irritability due to low extracellular calcium levels 1. These signs are critical in diagnosing hypocalcemia, particularly in patients with chronic kidney disease (CKD) where serum calcium levels can fluctuate significantly. Some key signs of hypocalcemia include:
- Chvostek's sign: facial muscle twitching when tapping the facial nerve anterior to the ear
- Trousseau's sign: carpopedal spasm induced by occluding blood flow to the arm with a blood pressure cuff for 3 minutes
- Tetany: muscle cramps and spasms
- Paresthesias: numbness or tingling sensations in the extremities
- Seizures: in severe cases, hypocalcemia can trigger seizures, particularly in patients with underlying parathyroid dysfunction 1. It's essential to assess for these signs systematically, considering that symptoms typically appear when serum calcium levels fall below 8.0 mg/dL, with more severe manifestations occurring at lower levels 1. Regular investigations, including measurements of pH-corrected ionized calcium, magnesium, parathyroid hormone, and creatinine concentrations, are recommended to monitor and manage hypocalcemia effectively 1. Daily calcium and vitamin D supplementation are also recommended for patients with hypocalcemia, particularly those with CKD or 22q11.2 deletion syndrome 1.
From the Research
Signs of Hypocalcemia
- Tetany, including Chvostek's and Trousseau's signs 2
- Seizures 2
- Diminished to absent deep tendon reflexes 2
- Papilledema 2
- Mental changes, such as:
- Skin changes 2