Chvostek's sign and Trousseau's sign both appear in a patient on post-operative day 1 after total thyroidectomy. Serum corrected calcium is 1.85 mmol/L. The first-line acute management is:

• A Oral calcium carbonate 1 g three times daily
• B Intravenous calcium gluconate infusion ✓
• C Subcutaneous teriparatide injection
• D Intravenous magnesium sulphate

Explanation

Symptomatic hypocalcaemia (tetany, positive Chvostek/Trousseau signs) with corrected calcium below 1.9 mmol/L requires intravenous calcium gluconate to rapidly restore ionised calcium. Oral calcium takes hours to be absorbed and is insufficient for symptomatic hypocalcaemia. Teriparatide is used in chronic hypoparathyroidism unresponsive to conventional therapy, not acute postoperative hypocalcaemia.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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