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 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.
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 calcium infusion doesn’t control seizures, administer a sedative, such as chloral hydrate or phenobarbital.
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. Ask the patient if he had recent puncture wounds, and inquire about his immunizations.
During the history, form a general impression of the patient’s mental status and behavior. If possible, ask family members or friends if they have noticed changes in the patient’s behavior. Mental confusion or even personality changes may occur with hypocalcemia.
Take the patient’s vital signs. Hypocalcemia may result in hypotension and an irregular heart rhythm. Check for Chvostek’s sign, also an indicator of hypocalcemia. Then proceed to perform a complete physical examination. Inspect the patient’s skin and fingernails, noting any dryness or scaling or ridged, brittle nails caused by 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.
With tetanus, an infectious disease caused by Clostridium tetani, 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.
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.
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.
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.
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.
Teach the patient the importance of receiving immunization against tetanus and of keeping a vaccination record. If you have any doubt about a patient’s 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.
Review other book chapters online related to Tetany:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Signs & Symptoms: A 2-in-1 Reference for Nurses Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-318-1 
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