Clinical manifestations-hypocalcemia

• Neuromuscular irritability: perioral paresthesias, cramps, ⊕ Trousseau’s (inflation of BP cuff ≥3 min → carpal spasm), ⊕ Chvostek’s (tapping facial nerve → contraction of facial muscles), laryngospasm; irritability, depression, psychosis, seizures, ↑ QT

  • 神經肌肉過敏：口周感覺異常、痙攣(手、臉、喉、腦)
  • ⊕ Trousseau’s（BP 袖帶充氣≥3 分鐘 → 腕部痙攣）
  • ⊕ Chvostek’s（敲擊面神經 → 面部肌肉收縮）啾咪Sign
    • “Chvostek sign” is pronounced: vos-tek
  • 喉痙攣；
  • 易怒、抑鬱、精神病、癲癇發作，↑ QT

• Rickets and/or osteomalacia: chronic ↓ vit D → ↓ Ca, ↓ PO4 → ↓ bone/cartilage mineralization, growth failure, bone pain, muscle weakness

• Renal osteodystrophy: osteomalacia [↓ mineralization of bone due to ↓ Ca and 1,25-(OH)2D] & osteitis fibrosa cystica (due to ↑ PTH), adynamic bone disease or mixed uremic osteodystrophy; dx by bone biopsy

  • 腎性骨營養不良：骨軟化症 [↓ Ca 和 1,25-(OH)2D 導致的骨礦化] 和纖維囊性骨炎（↑ PTH 導致）、無動力性骨病或混合性尿毒症性骨營養不良； dx 通過骨Bx