A patient is admitted to the hospital with a calcium level of 6.0 mg/dL. Which of the following symptoms would you not expect to see in this patient?
A. Numbness in hands and feet
B. Muscle cramping
C. Hypoactive bowel sounds
D. Positive Chvostek’s sign
Correct Answer: C. Hypoactive bowel sounds
Normal serum calcium is 8.5 – 10 mg/dL. The patient is hypocalcemic. Increased gastric motility, resulting in hyperactive (not hypoactive) bowel sounds, abdominal cramping and diarrhea is an indication of hypocalcemia. Hypocalcemia is said to be present when the total serum calcium concentration is less than 8.8 mg/dl. The disorder may be acquired or inherited but its presentation can vary- from asymptomatic to life-threatening. Hypocalcemia is commonly seen in hospitalized patients and for the most part, is mild in nature and only requires supportive treatment.
Option A: Paresthesias can be perioral or otherwise. Carpopedal spasm, also referred to as Trousseau’s sign. It represents increased neuromuscular excitability which may be related to the gating function of calcium ions for ion channels at a cellular level (particularly in neurons). This manifests as a spasm of hand upon routine BP check.
Option B: Numbness in hands and feet and muscle cramps are also signs of hypocalcemia. Tetany is generally induced by a rapid decline in serum ionized calcium. Tetany is usually most dangerous and most commonly seen in the presence of respiratory alkalosis causing hypocalcemia.
Option D: Positive Chvostek’s sign refers to the sustained twitching of facial muscles following tapping in the area of the cheekbone and is a hallmark of hypocalcemia. Another manifestation of heightened neuromuscular excitability. It is the spasm of facial muscles in response to tapping the facial nerve near the angle of the jaw.