1. General information
    1. Disorder characterized by hypocalcemia resulting from a deficiency of parathormone (PTH) production
    2. May be hereditary, idiopathic, or caused by accidental damage to or removal of parathyroid glands during surgery, e.g., thyroidectomy
  2. Assessment findings
    1. Acute hypocalcemia (tetany)
      1. Tingling of fingers and around lips, painful muscle spasms, dysphagia, laryngospasm, seizures, cardiac arrhythmias
      2. Chvostek's sign: sharp tapping over facial nerve causes twitching of mouth, nose, and eye
      3. Trousseau's sign: carpopedal spasm induced by application of blood pressure cuff for 3 minutes
    2. Chronic hypocalcemia
      1. Fatigue, weakness, muscle cramps
      2. Personality changes, irritability, memory impairment
      3. Dry, scaly skin; hair loss; loss of tooth enamel
      4. Tremor, cardiac arrhythmias, cataract formation
      5. Diagnostic tests
        1. serum calcium levels decreased
        2. serum phosphate levels elevated
        3. skeletal x-rays reveal increased bone density
  3. Nursing interventions
    1. Administer calcium gluconate by slow IV drip as ordered for acute hypocalcemia.
    2. Administer medications for chronic hypocalcemia.
      1. Oral calcium preparations: calcium gluconate, lactate, carbonate (Os-Cal)
      2. Large doses of vitamin D (Calciferol) to help absorption of calcium
      3. Aluminum hydroxide gel (Amphogel) or aluminum carbonate gel, basic (Basaljel) to decrease phosphate levels
    3. Institute seizure and safety precautions.
    4. Provide quiet environment free from excessive stimuli.
    5. Monitor for signs of hoarseness or stridor; check for Chvostek's and Trousseau's signs.
    6. Keep emergency equipment (tracheostomy set, injectable calcium gluconate) at bedside.
    7. For tetany or generalized muscle cramps, may use rebreathing bag to produce mild respiratory acidosis.
    8. Monitor serum calcium and phosphate levels.
    9. Provide high-calcium, low-phosphorus diet.
    10. Provide client teaching and discharge planning concerning
      1. Medication regimen; oral calcium preparations and vitamin D to be taken with meals to increase absorption
      2. Need to recognize and report signs and symptoms of hypo/hypercalcemia
      3. Importance of follow-up care with periodic serum calcium levels