A lactating mother with carpopedal spasm comes to the emergency department. What will be the initial action?

NORCET 2 -2021 (Shift-2)

Obstetrics & Gynaecology

Hard

Appeared in: NORCET 2 -2021 (Shift-2)

Explanation

The patient's carpopedal spasm is a sign of tetany, a medical emergency caused by acute hypocalcemia.
The immediate treatment is intravenous (IV) calcium to correct the deficiency and resolve neuromuscular irritability.
Calcium Gluconate is the appropriate medication for this condition.
Crucially, the administration must be slow, typically 10 mL over 10 minutes, to prevent life-threatening cardiac side effects.
A rapid IV push or 'bolus' is contraindicated as it can cause cardiac arrhythmias, bradycardia, and hypotension.

Option A: A 'bolus' implies a rapid IV push, which is extremely dangerous when administering calcium. It can lead to severe cardiac complications, including bradycardia and cardiac arrest.
Option B: This is the incorrect medication. Magnesium sulfate is used to treat hypomagnesemia or eclampsia, not as the primary intervention for hypocalcemic tetany.
Option C: This is the incorrect medication for the presenting problem. Although the administration rate is slow, the drug itself is not the first-line treatment for hypocalcemia.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Emergency management of acute symptomatic hypocalcemia as background academic context rather than a clinical decision trigger.
Nurses must be able to rapidly identify signs of tetany, such as carpopedal spasm, as it signifies a life-threatening electrolyte imbalance requiring immediate intervention.
The safe administration of IV calcium is a critical nursing responsibility. This includes using an infusion pump, continuous cardiac monitoring, and ensuring IV patency to prevent extravasation.
What if the patient's ECG showed a prolonged QT interval? This finding is consistent with hypocalcemia and would further heighten the need for slow, cautious calcium infusion and continuous cardiac monitoring, as the risk for arrhythmias like Torsades de Pointes is increased.

How to Approach the Question

First, analyze the patient's presentation. 'Lactating mother' is a risk factor for calcium depletion. 'Carpopedal spasm' is a classic, specific sign of tetany.
Connect the risk factor and the clinical sign to identify the underlying problem: acute symptomatic hypocalcemia.
Recall the emergency treatment for hypocalcemia, which is intravenous calcium.
Examine the options carefully, paying close attention to both the drug and the method of administration.
Differentiate between 'bolus' (rapid push) and a slow infusion ('over 10 min').
Select the option that represents the safest and most effective treatment protocol. Recognize that rapid IV calcium is dangerous, making the slow infusion the only correct choice.

Concept Tested & Keywords

Concept Tested: Emergency management of acute symptomatic hypocalcemia
Stem keywords: lactating mother, carpopedal spasm, emergency department, initial action
Lead-in keywords: initial action
Clinical cues: Carpopedal spasm is a classic sign of tetany, indicating severe hypocalcemia.
Clinical cues: Lactation is a significant risk factor for hypocalcemia due to calcium loss through breast milk.

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