Hypocalcemia may present with a variety of clinical signs and symptoms (T§bie,.2.) that relate to increased neuronal irritability. Cardiovascular manifestations are the most commonly encountered features in critically ill hypocalcemic patients. Patients may develop hypotension, cardiac insufficiency, arrhythmias (e.g. bradycardia, prolonged QT interval, and ventricular tachycardia and fibrillation), and failure to respond to drugs that act through calcium-related mechanisms (e.g. digoxin, norepinephrine (noradrenaline), and dopamine). Hypocalcemia should always be considered in patients with hypotension that responds poorly to fluids or pressor agents. Hypocalcemia may also present as laryngospasm in critically ill patients after neck surgery. Patients who had been doing well and were extubated after neck surgery have required reintubation as a result of laryngospasm. Tetany with muscle spasm is rarely seen in the ICU. Chovestek's and Trousseau's signs are indicators of peripheral nerve irritability during hypocalcemia ( L®b2w,!iz.,§nd,Mo§§s,1992,).
Table 2 Clinical features of hypocalcemia
Hypocalcemic symptoms are notoriously difficult to elicit in critically ill patients. Anticonvulsant drugs, sedation, and paralysis may mask signs of neuronal irritability. Intubated, sedated, and paralyzed patients may be unable to express symptoms such as anxiety and parasthesias. Psychiatric manifestations of hypocalcemia (such as depression and psychosis) are non-specific and are frequently seen in critically ill patients as a result of their illness. Hence it is important to monitor calcium levels routinely in all patients.
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