Reference — Electrolytes
Chvostek & Trousseau Signs Reference
Two quick bedside tests for latent tetany — the hyperexcitable nerves of hypocalcemia (and hypomagnesemia). Chvostek is the cheek tap; Trousseau is the cuff-induced hand spasm.
Educational use only. These signs support, but do not replace, serum calcium/magnesium measurement and provider evaluation. This reference is an educational aid. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
The Two Signs
| Sign | How to elicit | Positive result |
|---|---|---|
| Chvostek's sign | Tap over the FACIAL nerve just anterior to the ear (over the cheek/masseter) | Twitching of the facial muscles, lip, or nose on that side |
| Trousseau's sign | Inflate a BP cuff on the arm above systolic for ~3 minutes | Carpal (hand/wrist) SPASM — flexed wrist, thumb drawn in (more specific) |
Memory aid: Chvostek = Cheek; Trousseau = Trap the arm (BP cuff). Trousseau is generally the more specific sign.
What a Positive Sign Means
Both signs reflect neuromuscular hyperexcitability from low ionized calcium — “latent tetany” that can progress to overt tetany, laryngospasm, and seizures. Causes include hypocalcemia (hypoparathyroidism, post-thyroidectomy, vitamin D deficiency, CKD with high phosphate), hypomagnesemia, and respiratory alkalosis (hyperventilation lowers ionized calcium). A positive sign is a prompt to check calcium and magnesium and watch the airway.
Nursing Actions
If positive: notify the provider, check calcium/magnesium and an ECG (QT), and institute seizure and emergency airway precautions (laryngospasm risk). Anticipate calcium (and magnesium) replacement — IV calcium gluconate for severe/symptomatic hypocalcemia on a monitor. These signs are also the routine bedside check after thyroid/parathyroid surgery, where falling calcium is expected in the first days.
NCLEX Pearls
- ✦Chvostek = cheek/facial twitch when tapping the facial nerve; Trousseau = carpal spasm with a BP cuff.
- ✦Both indicate latent tetany — usually hypocalcemia (also hypomagnesemia, alkalosis).
- ✦Trousseau is the more specific of the two.
- ✦Positive sign → check Ca and Mg, watch the airway, seizure precautions, anticipate calcium replacement.
- ✦Routine check after thyroid/parathyroid surgery (post-op hypocalcemia).
Related Resources
Standards & sources
Fact-checked Jun 20, 2026This page is written to align with Infusion Nurses Society (INS) Standards of Practice · Institute for Safe Medication Practices (ISMP) · Standard laboratory reference ranges. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →