Hello everyone,
what is the normal range of calcium 🙄?
it ranges from 9-11mg/dl
if it is 7-9 mg/ dl it gives us Latent tetany.
If it is < 7 mg/dl it gives us manifest tetany.
So , we should know What are the causes of hypocalcemia🙄?
1-as a complication of infantile rickets when the parathyroid fails to compensate as in hypo parathyroidism .
2-Alkalosis (in alkalosis :the amount of ionized calcium is decreased and protein bounded calcium increased)
- Excess vomiting
- hyperventilation
postacidotic tetany due to rapid over correction with bicarbonates
3-hypomagnesmia as it is very impotant for the parathyroid function.
Clinical picture:
Latent tetany
1-chvostek’s sign: when you tap over the facial nerve in front of the ear there will be twitching of the muscles.
2-peroneal sign: tapping on the peroneal nerve at the fibula neck there will be twiches.
3-Trouasseau’ sign: inflation of the sphygmomanometer over the systolic for more than 4 minutes there will be twiches of the the muscles.
4-erb’s sign: applying a current < 5 mA causes contraction.
Manifest tetany
1-carpo-pedal spasm( extension of the in the interpharyngeal Joints , flexion of metacarpo-pharyngeal,adduction of the thumb,flexion of the wrist,extension and adduction of the feet and planter flexion of the toes.
2-laryngeal spasm
3-generalized convulsions
Diagnosis made by:
clinical +lab ( ca<9) + radiology if rickets suspected
Treatment
Emergency:1-Iv calcium gluconate slowly 5-10 ml of 10% solution over 10 minutes
2- iv diazepam for the convulsions.3mg/kg/day
3-oxygen inhalation for the laryngeal spasm
Maintenance
1-oral ca gluconate 200-500mg/kg/day divided
2- oral vit D 4000 iu for 3 weeks in case of rickets
3-treat the cause
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