Department of Endocrinology, Sacred Heart Hospital, Pensacola, FL 32504, USA
Ben-Jiang Ma (E-mail: firstname.lastname@example.org)
Clinical examinations; Clinical medicine; Diagnostic medicine; Endocrinology; Hematology; Internal medicine; Medicine; Nutrition; Physiology
Calcium is one of the most abundant ions in the body, the homeostasis of which is important for the normal functioning of the entire body system. Hypocalcemia is a commonly encountered clinical condition in hospitalized patients. Signs and symptoms of hypocalcemia may include neuromuscular, cardiac and psychiatric dysfunctions. Severe hypocalcemia (ionized calcium < 3.6 mg/dL) without neuromuscular symptoms is quite uncommon. Here we report an elderly female patient who was relatively asymptomatic with ionized calcium of 2.9 mg/dL on initial presentation. Subsequent studies revealed low levels of magnesium, vitamin D, and vitamin A, along with hypoalbuminemia, microcytic anemia and hypothyroidism that required high dose of levothyroxine. These data suggested that her severe hypocalcemia was probably caused by malnutrition due to malabsorption. Treatment with calcium supplement was not successful until the magnesium level was corrected. Her parathyroid hormone was inappropriately low at 52.0 pg/mL initially, and rose to 190.3 pg/mL after correction of magnesium. This case suggests that magnesium correction is paramount for treating hypocalcemia, and over supplement of calcium should be avoided in chronic, well-tolerated hypocalcemic patients to prevent hypercalcemic symptoms.
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