Master Hypocalcemia with Picmonic for Physician Assistant

Hypocalcemia is defined as a serum calcium level below 8.5 mg/dL.

Decreased bone density (osteoporosis) occurs as calcium is moved from bone storage sites. The bones become brittle and fragile, making them prone to breaking with even the slightest of trauma.

Tetany is characterized by spasms of the hands and feet, cramps, spasms of the voice box, and overactive neurological reflexes.

Chvostek's sign is a sign observed in those with low calcium. To test for it, tap directly along the facial nerve, on or around the cheek and anterior to the ear, to trigger facial twitching of one side of the mouth, nose and cheek. Twitching of the facial muscles is a positive sign of hypocalcemia.

Trousseau's sign is a sign observed in those with low calcium. To test for it, begin by placing a blood pressure cuff around the upper arm, inflate the cuff to greater than the patient's systolic pressure, and keep it inflated for 1-4 minutes. Under these peripheral hypoxic conditions, a positive Trousseau's sign occurs when the hand and fingers go into spasm in palmar flexion.

Low levels of calcium cause the muscles to contract more easily, leading to increased deep tendon reflexes. This is due to the fact that calcium affects contractility of muscle fibers.

Hypocalcemia results in ECG changes which includes a prolonged QT interval and prolonged ST segment. This can cause decreased myocardial function and increase the risk for developing abnormal rhythms resulting from increased cardiac cell excitability.

Hypocalcemia results in EKG changes which includes a prolonged QT interval and prolonged ST segment. This can cause decreased myocardial function and increase the risk for developing abnormal rhythms resulting from increased cardiac cell excitability.

Direct calcium replacement, through oral or IV routes, should be initiated to treat hypocalcemia. Calcium gluconate is often preferred over calcium chloride, as it is less necrotic to tissues.

Because excitable membranes of the nervous system and skeletal system are overstimulated, seizure precautions should be initiated. This includes keeping the bed in a low, locked position with the siderails up, ensuring that emergency equipment is at the bedside, and that IV access has been started.