Carpopedal spasm
Carpopedal spasm: Excerpt from Handbook of Signs & Symptoms (Third Edition)
Carpopedal spasm is the violent, painful contraction of the muscles in the hands and feet. (See Recognizing carpopedal spasm, page 126.) It's an important sign of tetany, a potentially life-threatening condition characterized by increased neuromuscular excitation and sustained muscle contraction and is commonly associated with hypocalcemia.
Carpopedal spasm requires prompt evaluation and intervention. If the primary event isn't treated promptly, the patient can also develop laryngospasm, seizures, cardiac arrhythmias, and cardiac and respiratory arrest.
Emergency interventions
If you detect carpopedal spasm, quickly examine the patient for signs of respiratory distress (laryngospasm, stridor, loud crowing noises, cyanosis) or cardiac arrhythmias, which indicate hypocalcemia. Obtain blood specimens for electrolyte analysis (especially calcium), and perform an electrocardiogram. Connect the patient to a cardiac monitor to watch for the appearance of arrhythmias. Administer an I.V. calcium preparation, and provide emergency respiratory and cardiac support. If calcium infusion doesn't control seizures, administer a sedative, such as chloral hydrate or phenobarbital.
History and physical examination
If the patient isn't in distress, obtain a detailed history. Ask about the onset and duration of the spasms and ask for a description of pain they produce. Also ask about related signs and symptoms of hypocalcemia, such as numbness and tingling of the fingertips and feet, other muscle cramps or spasms, and nausea, vomiting, and abdominal pain. Check for previous neck surgery, calcium or magnesium deficiency, tetanus exposure, and hypoparathyroidism.
During the history, form a general impression of the patient's mental status and behavior. If possible, ask family members or friends if they've noticed changes in the patient's behavior. Mental confusion or even personality changes may occur with hypocalcemia.
Inspect the patient's skin and fingernails, noting dryness or scaling and ridged, brittle nails.
Medical causes
Hypocalcemia.
Carpopedal spasm is an early sign of hypocalcemia. It's usually accompanied by paresthesia of the fingers, toes, and perioral area; muscle weakness, twitching, and cramping; hyperreflexia; chorea; fatigue; and palpitations. Positive Chvostek's and Trousseau's signs can be elicited. Laryngospasm, stridor, and seizures may appear in severe hypocalcemia.
Chronic hypocalcemia may be accompanied by mental status changes; cramps; dry, scaly skin; brittle nails; and thin, patchy hair and eyebrows.
Tetanus.
Tetanus develops when Clostridium tetani enters a wound in a nonimmunized individual. The patient develops muscle spasms and painful seizures. Difficulty swallowing and a low-grade fever are also present. If the patient isn't treated or treatment is delayed, the mortality rate is very high.
Other causes
Treatments.
Multiple blood transfusions and parathyroidectomy may cause hypocalcemia, resulting in carpopedal spasm. Surgical procedures that impair calcium absorption, such as ileostomy formation and gastric resection with gastrojejunostomy, may also cause hypocalcemia.
Special considerations
Carpopedal spasm can cause severe pain and anxiety, leading to hyperventilation. If this occurs, help the patient slow his breathing through your relaxing touch, reassuring attitude, and clear directions about what he should do. Provide a quiet, dark environment to reduce his anxiety.
Prepare the patient for laboratory tests, such as complete blood count and serum calcium, phosphorus, and parathyroid hormone studies.
Pediatric pointers
Idiopathic hypoparathyroidism is a common cause of hypocalcemia in children. Carefully monitor children with this condition because carpopedal spasm may herald the onset of epileptiform seizures or generalized tetany followed by prolonged tonic spasms.
Geriatric pointers
Always ask elderly patients about their immunization record. Suspect tetanus in anyone who comes to your facility with carpopedal spasm, difficulty swallowing, and seizures. Such patients may have incomplete immunizations or may not have had a recent booster shot. Always ask about any recent wound, no matter how inconsequential it may seem.
Pictures
Book Source Details
- Book Title: Handbook of Signs & Symptoms (Third Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.
More About Hypocalcemia
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Review other book chapters online related to Hypocalcemia:
Medical Books Excerpts
- Carpopedal spasm
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Hypocalcemia (A Pocket Manual of Differential Diagnosis)
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