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Hypocalcemia Surveillance, Total Thyroidectomy — Monitor for Symptoms of Hypo/Hypercalcemia — Clinical Pathway: Inpatient and Outpatient Specialty Care

Thyroidectomy Calcium Management Clinical Pathway — Inpatient and Outpatient Specialty Care

Monitor for Symptoms of Hypocalcemia

Calcium homeostasis is regulated by parathyroid hormone (PTH) and vitamin D. PTH increases serum calcium through several mechanisms.

  • Directly increases reabsorption in the distal renal tubule
  • Stimulates 1-alpha-hydroxylase in the kidney
    • 25-hydroxyvitamin D converts to 1, 25-dihydroxyvitamin D, active form
  • Mobilizes calcium from the bone
Signs and Symptoms of Hypocalcemia
Symptoms
  • Perioral numbness
  • Tingling of the hands or feet
  • Anxiety, depression
  • Fatigue
Signs
  • Hypotension
  • Tetany
  • Muscle cramps and/or spasms (especially during measurement of blood pressure)
  • Papilledema
  • Stridor
  • Laryngospasm (dysphagia or change in voice)
  • Focal or generalized seizures
  • Prolonged QT or QTc on EKG
  • Trousseau’s sign
    • Induction of carpopedal spasm by inflation of a sphygmomanometer above systolic blood pressure for 3 minutes
  • Chvostek’s sign
    • Contraction of ipsilateral facial muscles elicited by tapping facial nerve anterior to ear;
    • Note: occurs in ~10% of normal individuals

 

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