398 Emergency Medicine
paresthesias, carpal spasm, and tetany. This occurs as a result of an alkalemic
environment that decreases ionized calcium levels. The treatment is reas-
surance, a rebreathing mask allowing for carbon dioxide retention and possi-
bly sedation. The patient’s metabolic profile is consistent with a respiratory
alkalosis (elevated pH, low carbon dioxide). The blood gas indicates a pure
alkalosis therefore an acidosis is not seen (a and c). The bicarbonate level
is normal and therefore it is not caused by a metabolic disturbance (b).
Patients with hyperthyroidism (e)may be tachycardic, hyperthermic with
an elevated BP. Upon physical examination, these patients may also appear
to be underweight, have bulging eyes (exophthalmos) and complain of pal-
pitations, diarrhea, tremors, and generalized anxiety. Hyperthyroidism is
not a direct cause of tetany.