Chronic hypocalcemia is less common than hypercalcemia, and is usually symptomatic and requires treatment. Symptoms include peripheral and perioral paresthesia, muscle spasms, carpopedal spasm, tetany, laryngeal spasm, seizure, and respiratory arrest. Increased intracranial pressure and papilledema may occur with long-standing hypocalcemia, and other manifestations may include irritability, depression, psychosis, intestinal cramps, and chronic malabsorption. Chvostek’s and Trousseau’s signs are frequently positive, and the QT interval is prolonged. Both hypomagnesemia and alkalosis lower the threshold for tetany.