Parathyroid Disorders

First Things First (assess & treat for the following)


  • Does pt have severe hypercalcemia requiring immediate attention?
    • Corrected serum calcium >3.5 above upper limit of normal or ionized calcium level >20% above normal value and
      • Evidence of shock due to volume depletion
      • Mental status changes (psychosis, lethargy, stupor, coma)
      • EKG changes (short QT, arrhythmias)
      • Nausea, vomiting, and abdominal pain
      • Renal failure


  • Does pt have severe hypocalcemia requiring immediate attention?
    • Corrected serum calcium < 7.5 mg/dL or ionized calcium level < 80% of normal values and
      • Frank tetany, laryngospasm, perioral numbness and carpopedal spasms
        • Chvostek’s sign and Trousseau’s sign (which is more specific for hypocalcemia)
      • Arrhythmias: long QT, bradycardia, heart block, cardiac arrest
      • Hypotension, heart failure

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Last updated: May 10, 2010