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Key Features

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  • Tetany with facial and extremity numbness, tingling, cramps, spontaneous muscle contractures, carpopedal spasm, positive Trousseau and Chvostek signs, loss of consciousness, and convulsions

  • Diarrhea, prolongation of electrical systole (QT interval), and laryngospasm

  • In hypoparathyroidism or pseudohypoparathyroidism (PHP): defective nails and teeth, cataracts, and ectopic calcification in the subcutaneous tissues and basal ganglia

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Clinical Findings

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  • Prolonged hypocalcemia from any cause is associated with tetany, photophobia, blepharospasm, and diarrhea

  • Symptoms of tetany include numbness, muscle cramps, twitching of the extremities, carpopedal spasm, and laryngospasm

  • Tapping the face in front of the ear causes facial spasms (Chvostek sign)

  • Some patients with hypocalcemia exhibit bizarre behavior, irritability, loss of consciousness, and convulsions

  • Headache, vomiting, increased intracranial pressure, and papilledema may occur

  • In early infancy, respiratory distress may be a presenting finding

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Diagnosis

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  • Magnesium levels may also be low

  • Measurement of urinary excretion of calcium (calcium-creatinine ratio) can assist in diagnosis and monitoring of therapy in children on calcitriol therapy

  • Various skeletal changes are associated with rickets, including cupped and irregular long bone metaphyses

  • Torsional deformities can result in genu varum (bowleg)

  • Accentuation of the costochondral junction gives the rachitic rosary appearance seen on the chest wall

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Treatment

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  • Administer intravenous calcium gluconate or calcium chloride at a dose of 10 mg/kg

  • Intravenous calcium infusions should not exceed 50 mg/min because of possible cardiac arrhythmia

  • Cardiac monitoring should be performed during calcium infusion

  • Calcium supplementation should start at a dose of 50–75 mg of elemental calcium per kilogram per day divided in three to four doses

  • Ergocalciferol (vitamin D2) and cholecalciferol (vitamin D3) are the most commonly used oral vitamin D preparations

    • Cholecalciferol is slightly more active than ergocalciferol

    • Calcitriol (1,25-dihydroxy vitamin D3) supplementation is recommended for impaired metabolism of dietary vitamin D to 25-OH vitamin D as seen in hepatic dysfunction, or to its active end product, 1,25-dihydroxy vitamin D, or impaired PTH function

    • Selection and dosage of vitamin D supplements varies with the underlying condition and the response to therapy

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