A 3 1 year-old male complained that his lips were numb and could not be opened. The reason was unknown. His hands are like chicken feet, and his lower limbs and calves are numb. After half an hour, he relieved himself, accompanied by chills in his limbs and cold sweat all over his body. I feel the possibility of hypocalcemia is very high. Its clinical manifestations are:
(1) Muscle symptoms of nervous system When the blood calcium is lower than 1. 1 mmol/L or the blood calcium of acute hypocalcemia is between 1.75 ~ 1.9 mmol/L, symptoms of nervous system can be produced. The manifestations are as follows: ① paresthesia: numbness, ant walking and myalgia in lips, fingertips or feet.
② Convulsion: Slight stimulation can induce muscle spasm of limbs and face. Typical manifestations are tetany, that is, finger muscles are tense and contracted, metacarpophalangeal joints, palms and wrists are flexed, interphalangeal joints are straight, thumbs are adducted, and other fingers are closed, showing a midwife's hand or a chicken's paw hand. It can last for several minutes to several days. Usually the author disappears first.
③ Autonomic nerve dysfunction: it can cause smooth muscle spasm. For example, laryngeal and bronchial smooth muscle spasm can cause wheezing, intestinal smooth muscle spasm can cause abdominal pain and diarrhea, bile duct smooth muscle spasm can cause biliary colic, bladder smooth muscle spasm can cause urine sensation, and arterial smooth muscle spasm can cause headache, angina pectoris and Raynaud's syndrome.
④ Neuropsychiatric symptoms: weakness, anxiety, depression, anxiety, insomnia, memory loss, etc.
(2) The dystrophy of ectodermal tissue is characterized by cataract, keratinization of skin, tooth hypoplasia, nail and toenail embrittlement, alopecia, etc. It may be that vasospasm caused by hypocalcemia leads to insufficient blood supply.
(3) Skeletal changes Children with hypocalcemia may have rickets-like skeletal changes, while adults with hypocalcemia caused by pseudohypothyroidism may have rickets, fibrous osteitis and fibrocystic osteitis.
(4) Due to decreased gastric acid and indigestion, nausea, vomiting, abdominal pain, diarrhea and other digestive symptoms may occur; There may also be circulatory system damage such as arrhythmia and heart failure. ECG shows prolonged QT interval, low T wave and inversion. Metastatic calcification can induce different clinical manifestations due to calcium deposition in different soft tissues.
(5) Hypocalcemia crisis When the blood calcium is lower than 0.88 mmol/L, convulsions, seizures and severe asthma may occur due to severe muscle spasms. In severe cases, it will lead to heart failure and cardiac arrest.
Adult hypocalcemia should be considered:
1, hypoparathyroidism, including primary, secondary and pseudohypoparathyroidism.
2. vitamin d metabolism disorder.
3. Chronic renal insufficiency,
4, liver disease, intestinal malabsorption, insufficient intake, insufficient light;
5, long-term use of antiepileptic drugs (such as epilepsy, phenytoin sodium, phenobarbital, carbamazepine, etc. )
6. Hypocalcemia associated with malignant tumor.