# A post-thyroidectomy client has positive Chvostek sign, tingling around the mouth, and Ca 7.2 mg/dL. Which IV calcium preparation is preferred via peripheral line?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391828&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A post-thyroidectomy client has positive Chvostek sign, tingling around the mouth, and Ca 7.2 mg/dL. Which IV calcium preparation is preferred via peripheral line?

## Option

1. Calcium gluconate via peripheral IV — less likely to cause tissue necrosis if extravasation occurs (calcium chloride is reserved for central access in emergencies) **✔ Correct answer**
2. Calcium chloride via peripheral IV
3. IV potassium chloride
4. Oral calcium tablets only

**Correct answer: 1**

## Explanation

Correct (2): Calcium gluconate is preferred via peripheral access — less tissue-irritating. Calcium chloride contains 3× more elemental calcium but causes severe necrosis if extravasated and is reserved for central line use in cardiac arrest. (1) Tissue damage risk. (3) Acute symptomatic hypocalcemia needs IV. (4) Wrong drug.

## In-depth explanation

Memory Tip Hypocalcemia = "Chvostek (cheek tap = facial twitch) + Trousseau (tourniquet = carpal spasm)." Peripheral IV = calcium GLUconate; Central IV emergency = calcium chloride.

## Clinical scenario

Scenario 48-year-old female post-thyroidectomy with positive Chvostek sign, perioral tingling, Ca 7.2 mg/dL. Peripheral IV in place.

## Key concepts

- **Calcium gluconate** — Preferred IV calcium for peripheral access; less tissue-toxic.
- **Calcium chloride** — 3× more elemental Ca; severe tissue injury if extravasated; central line only.
- **Chvostek/Trousseau signs** — Facial twitch with cheek tap; carpal spasm with BP cuff — both signs of hypocalcemia.

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