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Grade Criteria Comments Classic Symptoms include pain, numbness, tingling, and burning in at least 2 digits (thumb, index, and long) Involvement of the fourth and fifth digits, wrist, and area proximal to the wrist is allowed
Involvement of the palm or dorsum of the hand is not allowedProbable Symptom pattern same as classic Palmar symptoms are allowed unless confined to the ulnar side Possible Symptoms involve only 1 digit (thumb, index, or long) Symptoms may involve the dorsum of the hand Unlikely No symptoms involving thumb, index, or long digit Test Valuea Reference range Complete blood cell count Hemoglobin (g/dL) 13.2 12.3–15.3 White blood cell count (× 109/L) 5.2 4.0–11.0 Platelet count (× 1012/L) 230 150–400 Sodium (mmol/L) 136 135–145 Potassium (mmol/L) 3.2 3.5–5.0 Blood urea nitrogen (mg/dL) 17 8–21 Creatinine (mg/dL) 0.9 0.8–1.3 Glucose (mg/dL) 224 70–99b Hemoglobin A1c (%) 9.7 < 5.7c Calcium (mg/dL) 5.7 8.9–10.1 Phosphate (mg/dL) 5.1 2.5–4.6 Albumin (g/dL) 3.2 3.5–5.0 Alanine aminotransferase (U/L) 12 8–40 Aspartate aminotransferase (U/L) 14 8–40 Intact parathyroid hormone (ng/L) 20 10–65 25-hydroxyvitamin D (ng/mL) 9.5 30–80 Thyroid-stimulating hormone (mIU/L) 7.8 0.5–5.0 General Fatigue Diaphoresis Neuromuscular Acral paresthesia Perioral numbness Muscle cramps and myalgias Tonic muscle contractions Carpopedal spasm (Trousseau sign) Chvostek sign Seizures Respiratory Bronchospasm Laryngospasm Ocular Papilledema Optic neuritis (rare) Cardiovascular Hypotension Hypocontractility, heart failure Ventricular tachycardia due to prolonged QT interval Heart block, conduction abnormalities Insensitivity to digitalis Psychiatric Anxiety, irritability Depression Confusion Emotional instability Hallucinations (rare) Psychosis (rare) Gastrointestinal Anorexia Abdominal cramps Biliary colic Gastric achlorhydria Steatorrhea Blood Decreased prothrombin (impaired coagulation) Neurologic Basal ganglia calcifications Parkinsonism Other extrapyramidal disorders Dementia Idiopathic intracranial hypertension Dental (during early development), skeletal Failure of tooth eruption Abnormal enamel Defective root formation Dental hypoplasia High bone density Ocular Subcapsular cataracts Keratoconjunctivitis (rare) Dermatologic Dry, coarse skin Brittle nails Brittle hair Patchy alopecia Serum parathyroid hormone level High serum phosphate End-stage renal diseasea
(estimated glomerular filtration rate < 15 mL/min)High Acute phosphate load High Endogenous source (rhabdomyolysis, tumor lysis syndrome) Exogenous source (eg, phosphate enemas) Primary hypoparathyroidism Low Pseudohypoparathyroidism High Low or normal serum phosphate Vitamin D deficiency High Vitamin D resistance High Hypomagnesemia Low Drugs (eg, bisphosphonates, denosumab, calcitonin, plicamycin, foscarnet, fluoride, intravenous contrast) High Acute pancreatitis High Sepsis High Massive blood transfusion, plasma exchange, leukapheresis High Acute respiratory alkalosis High Osteoblastic bone metastasis (breast, prostate cancer) High ↵a A high parathyroid hormone level in end-stage renal disease is due to secondary hyperparathyroidism.
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- Article
- POSSIBLE CAUSES OF NUMBNESS
- CLINICAL MANIFESTATIONS OF HYPOCALCEMIA
- STEPS TO DIAGNOSIS OF HYPOCALCEMIA
- PHOSPHATE IS OFTEN HIGH WHEN CALCIUM IS LOW
- CASE RESUMED: NO RESPONSE TO INTRAVENOUS CALCIUM GLUCONATE
- CASE RESUMED
- PREVENTING HYPERCALCIURIA
- PRIMARY HYPOPARATHYROIDISM: LONG-TERM MANAGEMENT
- CASE CONCLUDED
- TAKE-HOME POINTS
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