Carpopedal spasm
Carpopedal spasm: Excerpt from Professional Guide to Signs & Symptoms (Fifth Edition)
Carpopedal spasm is the violent, painful contraction of the muscles in the hands and feet. (See Recognizing carpopedal spasm.) It’s an important sign of tetany, a potentially life-threatening condition that is commonly associated with hypocalcemia and characterized by increased neuromuscular excitation and sustained muscle contraction.
Carpopedal spasm requires prompt evaluation and intervention. If not 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 samples 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. If a 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 the degree 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 because hypocalcemia can cause confusion and even personality changes.
Inspect the patient’s skin and fingernails, noting any 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 is an infectious disease that develops when Clostridium tetani enters a wound in a nonimmunized individual. The patient develops muscle spasms, painful seizures, difficulty swallowing, and a low-grade fever. Without prompt treatment, mortality 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 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 any recent wound, no matter how inconsequential it may seem.
Patient counseling
Teach the patient the importance of receiving immunization against tetanus and of keeping a vaccination record. If you have any doubt about his vaccination record, you must give him the vaccine. Tetanus toxoid booster shots must be given every 10 years after the patient has been properly immunized in childhood.
Pictures
Book Source Details
- Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.
More About Tetanus
More Medical Textbooks Online about Tetanus
Review other book chapters online related to Tetanus:
Medical Books Excerpts
- JAW PAIN
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- Jaw pain
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Tetanus
- "Professional Guide to Diseases (Eighth Edition)" (2005)
- [ read ]
- Jaw pain
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Carpopedal spasm
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Jaw pain
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Jaw pain
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Jaw pain
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
- Tetanus
- "The 5-Minute Pediatric Consult" (2008)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Jaw pain (Professional Guide to Signs & Symptoms (Fifth Edition))
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
