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The symptoms of hypocalcemic tetany may be confused with paresthesias, muscle cramps, or tetany due to respiratory alkalosis, in which the serum calcium is normal In fact, hyperventilation tends to accentuate hypocalcemic symptoms Chronic hypocalcemia can cause heart failure and be confused with myocardial infarction and ischemic cardiomyopathy At times hypoparathyroidism is misdiagnosed as idiopathic epilepsy, choreoathetosis, or brain tumor (on the basis of brain calcifications, convulsions, choked disks) or, more rarely, as asthma (on the basis of stridor and dyspnea) Hypocalcemia is frequently seen in patients with hypoalbuminemia; serum levels of ionized calcium are normal Hypocalcemia may also be due to malabsorption of calcium, magnesium, or vitamin D; patients do not always have diarrhea Hypocalcemia may also be caused by certain drugs: loop diuretics, plicamycin, phenytoin, alendronate, and foscarnet In addition, hypocalcemia may be seen in cases of rapid intravascular volume expansion or due to chelation from transfusions of large volumes of citrated blood Hypocalcemia is also frequently seen following parathyroidectomy for hyperparathyroidism It is also observed in patients with acute pancreatitis Hypocalcemia may develop in some patients with certain osteoblastic metastatic carcinomas (especially breast, prostate) instead of the expected hypercalcemia Hypocalcemia with hyperphosphatemia (simulating hypoparathyroidism) is seen in azotemia but may also be caused by large doses of intravenous, oral, or rectal phosphate preparations and by chemotherapy of responsive lymphomas or leukemias Hypocalcemia with hypercalciuria may be due to a familial syndrome involving a mutation in the calcium-sensing receptor; such patients have levels of serum PTH that are in the normal range, distinguishing it from hypoparathyroidism It is transmitted as an autosomal dominant disorder Such patients are hypercalciuric; treatment with calcium and vitamin D may cause nephrocalcinosis

A Emergency Treatment for Acute Attack (Hypoparathyroid Tetany)

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The first style, used throughout this book, is to put the braces under the keyword if and to indent the contents of the if block. The second style, which is not very popular anymore, is to indent the braces with the contents of the if block. The third style is to put the opening brace on the same line as the if statement and the closing brace under the if statement. The third style is called K&R style, after Brian W. Kernighan and Dennis M. Ritchie, the authors of the seminal book The C Programming Language (Prentice Hall). Their book was so influential that many programmers feel a strong commitment to this style of braces. Although it does save room in a book, we consider the K&R style to be a bit less clear, and so this book will use the first style. Of course, most software departments have standards or guidelines of their own, which usually include rules about indentation and braces. You should always follow your company s official guidelines, but know that all three of these styles work.

This usually occurs after surgery and requires immediate treatment 1 Airway Be sure an adequate airway is present

The goal should be to maintain the serum calcium in a slightly low but asymptomatic range (8 86 mg/dL) This will minimize the hypercalciuria that would otherwise occur and provides a margin of safety against overdosage and hypercalcemia, which may produce permanent damage to renal function

Available Preparations Ergocalciferol ergosterol, (vitamin D2, Calciferol) Cholecalciferol (vitamin D3) Calcitriol (Rocaltrol) Capsules of 50,000 IU; 8000 IU/mL oral solution Daily Dose 2000 200,000 units Duration of Action 1 2 weeks

System V Release 3.1 (1987)

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Capsules of 50,000 IU not available commercially in United States; may be compounded Capsules of 025 and 05 mcg; 1 mcg/mL oral solution; 1 mcg/mL for injection

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