What are classic signs of acute hypocalcemia and what is the initial ED treatment?

• A. Tetany, perioral numbness, Chvostek sign, Trousseau sign; treat with IV calcium gluconate and magnesium repletion if low
• B. Nausea and vomiting
• C. Chest pain
• D. Bradycardia with hypotension

Answer: (A)

Acute hypocalcemia causes increased neuromuscular excitability, leading to classic signs such as tetany, numbness around the mouth, and positive Chvostek and Trousseau signs. In the emergency department, the priority is rapid correction of calcium to stabilize nerve and muscle membranes and protect the heart, which is achieved with IV calcium gluconate. Because low magnesium can accompany hypocalcemia and impede the body's ability to regulate calcium, magnesium repletion is indicated if magnesium is found to be low. After stabilization, continue to address the underlying cause and plan for longer-term management with calcium and vitamin D as appropriate. The other symptoms listed are not the hallmark signs or the primary ED treatment for acute hypocalcemia.