Acute Carpopedal Spasm During Medical Termination of Pregnancy: A Case of Hyperventilation-Induced Hypocalcemia

TL;DR

A woman undergoing medical termination of pregnancy experienced acute hand and foot spasms due to hyperventilation-induced low calcium levels, which resolved with calcium treatment.

Contribution

This case identifies hyperventilation-induced hypocalcemia as a reversible cause of acute neuromuscular symptoms during pregnancy termination.

Findings

Acute bilateral carpopedal spasms occurred after misoprostol administration due to respiratory alkalosis and low ionized calcium.

Symptoms resolved with intravenous calcium and after gestational sac expulsion.

No evidence of uterine rupture, pulmonary embolism, sepsis, or seizures was found.

Abstract

Acute neuromuscular symptoms during medical management of pregnancy loss are rare and may mimic life-threatening obstetric or neurologic emergencies. A 40-year-old multigravida woman at 14 weeks and 5 days of gestation was admitted for medical management of a missed abortion using sublingual misoprostol. Three hours after administration, she developed acute bilateral carpopedal spasms accompanied by hyperventilation, chest discomfort, agitation, and perioral numbness. Laboratory evaluation revealed marked respiratory alkalosis with reduced ionized calcium, while endocrine workup, including parathyroid hormone, vitamin D, and magnesium levels, was normal. Extensive assessment excluded uterine rupture, pulmonary embolism, sepsis, and seizure activity. Symptoms improved after intravenous calcium administration and resolved completely following expulsion of the gestational sac. This case highlights hyperventilation-induced respiratory alkalosis as a reversible cause of acute neuromuscular symptoms during medical management of pregnancy loss, underscoring the importance of prompt recognition, targeted treatment, and avoidance of unnecessary interventions.