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Injection Technique Repeated injections in the same spot can irritate tissue over time, especially if rotation is inconsistent

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Common Causes Hypoparathyroidism Post-thyroid or parathyroid surgery Autoimmune destruction Congenital absence of parathyroid glands Vitamin D Deficiency Poor dietary intake Malabsorption Chronic kidney disease Renal Failure Reduced vitamin D activation Hyperphosphatemia Other Causes Acute pancreatitis Severe sepsis Massive blood transfusion (citrate binding calcium) Drugs (e.g., bisphosphonates) Clinical Features Neuromuscular Irritability Perioral numbness Paresthesia of hands and feet Muscle cramps and tetany Classic Signs Chvosteks sign facial muscle twitching when tapping facial nerve Trousseaus sign carpal spasm after inflating BP cuff Cardiac Effects Prolonged QT interval on ECG Arrhythmias (rare) Investigations Serum total and ionized calcium Serum phosphate Parathyroid hormone (PTH) Vitamin D level Renal function tests ECG Management Acute Symptomatic Hypocalcemia IV Calcium Gluconate (slow infusion with ECG monitoring) Chronic Hypocalcemia Oral calcium supplements Vitamin D supplementation (calcitriol or cholecalciferol) Treat the underlying cause Important Tip Always check serum magnesium in hypocalcemia because hypomagnesemia can impair PTH secretion and worsen hypocalcemia

Weve gotten to this point where two large regulatory agencies dont really have authority over telehealth companies, she says