The clinical manifestations of hypoparathyroidism are due to hypocalcemia as decreased levels of parathyroid hormone lead to low serum calcium levels.
Lethargy is another common manifestation of hypocalcemia. The patient may also experience anxiety and personality changes.
Sudden decreases in calcium cause tetany (involuntary contraction of muscles). The patient may experience tingling of the lips and mouth or stiffness in the extremities.
Patients with hypoparathyroidism may experience dysrhythmias including a prolonged QT and ST segment.
Diagnostic tests confirming hypoparathyroidism will have a lower than normal serum calcium level and increased serum phosphorus levels.
IV calcium chloride (or calcium gluconate) may be given. Be sure to assess IV patency before administration of this drug as it can cause venous irritation and inflammation.
A rebreather mask decreases the amount of carbon dioxide excreted from the lungs, thereby increasing carbonic acid levels in the blood, and lowering pH. A lower pH promotes calcium ionization, allowing for more total body calcium to be available in the active form. This can temporarily alleviate acute neuromuscular symptoms associated with hypocalcemia.
Removal of the parathyroid glands will require lifelong medications to be taken. Due to the expense and need for parenteral administration, PTH replacement is not recommended, but instead the patient will need to take oral calcium and vitamin D supplements daily for life.
Oral calcium supplements can be taken to increase serum calcium levels. Vitamin D is often given concurrently as it helps the body absorb calcium and eliminate phosphorus.
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