Approach to hypocalcemia (pediatrics) Quiz: Ace Your Exams

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A 16-year-old girl is brought to the pediatrician’s office by her parents in winter for evaluation of muscle cramps and paresthesias of her hands and feet. The patient first noticed these symptoms a few months ago but reports that they have gotten worse and now bother her daily. She is an introvert and has limited physical activity, preferring to read in her room most days. She has some restrictive eating habits, which have worsened recently, for which she is seeing a therapist. Her weight is in the 23rd percentile and height is in the 42nd percentile. Temperature is 37.1°C (98.8°F), pulse is 92/min, respirations are 14/min, blood pressure is 110/78 mmHg, and oxygen saturation is 99% on room air. On examination, the patient is well-appearing and in no acute distress. Results of lab work are shown below. Which of the following findings would be expected given the most probable cause of her symptoms?

Laboratory value	Result
Complete blood count
Hemoglobin	13.9 g/dL
Hematocrit	41.7%
Leukocyte count	7,800/mm3
Platelet count	268,000/mm3
Serum chemistry
Sodium	140 mEq/L
Potassium	4.2 mEq/L
Chloride	102 mEq/L
Bicarbonate	24 mEq/L
Blood urea nitrogen	12 mg/dL
Creatinine	1.0 mg/dL
Glucose	95 mg/dL
Calcium	7.0 mg/dL
Vitamin B12	380 pg/mL
TSH	2 mIU/mL
Free T4	1.3 ng/dL
25-hydroxy vitamin D	7 ng/mL

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Contraction of the facial muscles with ipsilateral tapping of the facial nerve, flexion of the wrist with inflation of a sphygmomanometer, and prolonged QTc

Contraction of facial muscles with contralateral tapping of the facial nerve, flexion of the wrist with inflation of a sphygmomanometer, and arrhythmia

Contraction of facial muscles with contralateral tapping of the facial nerve, extension of the wrist with inflation of a sphygmomanometer, and papilledema

Contraction of facial muscles with ipsilateral tapping of the facial nerve, extension of the wrist with inflation of a sphygmomanometer, and laryngospasm

Contraction of facial muscles with ipsilateral tapping of the facial nerve, extension of the wrist with inflation of a sphygmomanometer, and perioral numbness.