Emesis, Electrolytes, and Extremities: A Case of Hypocalcemic Carpopedal Spasm

Hypocalcemia, characterized by low levels of ionized calcium, is a potentially life-threatening electrolyte disturbance that can result in neuromuscular symptoms such as tetany, carpopedal spasms, and seizures. This case report presents a 7-year-old previously healthy girl who developed painful bilateral carpopedal spasms following multiple episodes of non-bilious vomiting. Vomiting causes metabolic alkalosis, which subsequently led to a significant drop in ionized calcium levels, inducing hypocalcemia. On presentation, laboratory tests revealed low ionized calcium, though total calcium and other electrolytes were within normal limits. The patient was treated promptly with intravenous calcium gluconate and oral calcium supplementation, leading to a rapid resolution of her symptoms. She was discharged with continued oral calcium and regular follow-up. This case highlights the importance of considering hypocalcemia in pediatric patients presenting with carpopedal spasms, particularly in the context of metabolic disturbances caused by gastrointestinal issues such as vomiting. Early recognition and treatment of hypocalcemia are essential to prevent more severe complications such as seizures or laryngospasm. Clinicians must maintain a high index of suspicion for electrolyte imbalances in similar cases, and management should involve both immediate correction of calcium levels and addressing the underlying cause.