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Carpopedal spasm

Carpopedal spasm is the violent, painful contraction of the muscles in the hands and feet. (See Recognizing carpopedal spasm, page 70.) It’s an important sign of tetany, a potentially life-threatening condition characterized by increased neuromuscular excitation and sustained muscle contraction. Carpopedal spasm is commonly associated with hypocalcemia.

Carpopedal spasm requires prompt evaluation and intervention. If the causative factor isn’t identified and treated promptly, the patient can also develop laryngospasm, seizures, cardiac arrhythmias, and cardiac and respiratory arrest.

Act Now: 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 monitor to watch for the appearance of arrhythmias. Administer an I.V. calcium preparation and provide emergency respiratory and cardiac support, as ordered.  If calcium infusion doesn’t control the spasms, administer a sedative, as ordered.

Assessment

History

Ask the patient about the onset and duration of the spasms and the degree of pain they produce. Assess him for related signs and symptoms of hypocalcemia, such as numbness and tingling of the hands and feet, other muscle cramps or spasms, and nausea, vomiting, and abdominal pain. Determine whether the patient’s history includes previous neck surgery, calcium or magnesium deficiency, tetanus exposure, or hypoparathyroidism.

Ask the patient’s family members whether they noticed changes in his behavior. Mental confusion — even personality changes — may occur with hypocalcemia.

Physical examination

Inspect the patient’s skin and fingernails, noting dryness or scaling and ridged, brittle nails. Obtain his vital signs. Perform a head-to-toe assessment with a complete respiratory assessment. Check Chvostek’s sign (tapping of the facial nerve, which results in facial nerve spasm).

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 into 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 a recent wound, no matter how inconsequential it may seem.

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 is an infectious disease that develops when Clostridium tetani enters a wound in a nonimmunized individual. The patient develops muscle spasms and painful seizures. Difficulty swallowing and low-grade fever are also present. If the patient isn’t treated or treatment is delayed, the mortality rate is very high.

Other causes

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.

Nursing considerations

Prepare the patient for laboratory tests, such as complete blood count and serum calcium, phosphorus, and parathyroid hormone studies.

Carpopedal spasm can cause severe pain and anxiety; provide a quiet, dark environment to help the patient remain calm. Observe him closely for other signs of hypocalcemia until laboratory results rule out the disorder.

Patient teaching

Advise the patient to report numbness, tingling, or pain during hospitalization. If he has a disease that increases his risk of low serum calcium level, emphasize the need for dietary calcium replacement upon discharge from the hospital. Teach the patient the importance of receiving immunization against tetanus and keeping a vaccination record. If his immunization status is uncertain, he must receive the vaccine. Tetanus toxoid booster shots must be given every 10 years after the initial immunization.

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Book Source Details

• Book Title: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright Details: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, Copyright © 2008 Williams & Wilkins.

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• Back to symptom: Seizures: Introduction (review 2263 causes)
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More About This Book: Title: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-624-5

 » Next page: Fasciculations (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

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