A 43-year-old man comes to the emergency department due to painful muscle cramps. He also has had a tingling sensation around his mouth since earlier in the day and an intermittent sensation of choking in the throat. The patient reports a history of "high blood pressure and a thyroid disorder." On physical examination, he appears comfortable but anxious. Heart and lung sounds are normal. Light tapping anterior to the ear elicits twitching of the perioral muscles. Further discussion with this patient is most likely to reveal which of the following?

Question

A 43-year-old man comes to the emergency department due to painful muscle cramps.  He also has had a tingling sensation around his mouth since earlier in the day and an intermittent sensation of choking in the throat.  The patient reports a history of "high blood pressure and a thyroid disorder."  On physical examination, he appears comfortable but anxious.  Heart and lung sounds are normal.  Light tapping anterior to the ear elicits twitching of the perioral muscles.  Further discussion with this patient is most likely to reveal which of the following?

Quizplus · Accepted Answer

11ec160b_3b56_fa7b_9249_a36422ef0b62_MD0001_00 This patient has symptoms of hypocalcemia, including muscle cramps, perioral paresthesias, and possible laryngospasm. Other manifestations of hypocalcemia may include Chvostek sign (facial muscle contraction elicited by tapping on the facial nerve anterior to the ear) and Trousseau sign (carpopedal spasm triggered by prolonged inflation of a blood pressure cuff around the arm). These signs of neuromuscular hyperexcitability become clinically apparent with serum calcium levels ≤7.0 mg/dL. The most common cause of acute hypocalcemia is injury to the parathyroid glands during thyroid surgery due to direct trauma, devascularization, or inadvertent removal. Other causes of hypocalcemia include autoimmune hypoparathyroidism, sepsis, tumor lysis syndrome, acute pancreatitis, and severe vitamin D or magnesium deficiency. (Choices A, B, and C) Excessive intake of vitamin D or calcium-containing antacids can cause hypercalcemia. Thiazide diuretics (eg, chlorthalidone) also can cause mild hypercalcemia due to increased calcium resorption in the distal and collecting tubule of the nephron. Typical presenting symptoms of hypercalcemia include constipation, polyuria/polydipsia, and muscle weakness. (Choice D) Hyperthyroidism can cause hypercalcemia due to increased bone turnover. However, in hypothyroid states (eg, due to nonadherence to levothyroxine replacement) circulating calcium is usually normal. In general, hypothyroidism is characterized by chronic fatigue, weight gain, cold intolerance, and diminished reflexes. Educational objective: Hypocalcemia can cause muscle cramps, perioral paresthesias, hypotension, and neuromuscular hyperexcitability. Injury to the parathyroid glands during thyroid surgery is a common cause of hypoparathyroidism and acute hypocalcemia. __________ References: Clinical and biochemical factors affecting postoperative hypocalcemia after near-total thyroidectomy. (http://www.ncbi.nlm.nih.gov/pubmed/24285452)

A 43-Year-Old Man Comes to the Emergency Department Due to Painful