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• W3207641858 abstract "TOPIC: Disorders of the Pleura TYPE: Global Case Reports INTRODUCTION: Bilateral pleural effusions have diverse aetiology including reversible and irreversible causes. Electrolyte imbalances like hypocalcaemia causing a transudative pleural effusion due to associated cardiomyopathy are still rare but should be contemplated since they are reversible. Severe extracellular hypocalcemia impairs cardiac contractility and it may also cause neurological manifestations like muscle spasms, memory loss, seizures etc. We hereby present an interesting case of a young female with bilateral pleural effusion and seizure. CASE PRESENTATION: A 31-year-old female presented with complain of shortness of breath for 1 week and 2 episodes of tonic-clonic seizure. There was no history of epilepsy, but she had a history of total thyroidectomy 5 years back. She was put on medications following the procedure which she discontinued. At presentation, she had a BP of 80/60 mm Hg, heart rate was 160 bpm and SpO2 was 88% in room air. On auscultation there was decreased breath sounds in bilateral lower hemithorax. All routine investigations were normal except for low serum calcium level. Chest radiograph showed bilateral pleural effusion. Pleural fluid analysis was suggestive of transudative type with protein- 2.1, ADA 16 U/l and LDH- 98. Echocardiography showed dilated cardiomyopathy with left ventricular internal diameter of 6.1 cm and left atrium 4.1 cm. The left ventricular ejection fraction was 15%. The patient was started on inotropes, diuretics and calcium supplementation. Gradually resting SpO2 improved and inotropes were tapered. Calcium levels returned to normal and patient was discharged with calcium supplementation and thyroxin. Follow-up done at 2 weeks showed radiological improvement with improved ejection fraction [EF- 42%]. DISCUSSION: DCMP in hypocalcemia develops as a result of altered amplitude or duration of Ca2+ transient. Incidence of permanent hypocalcaemia after total thyroidectomy varies from 2-33%.(1). Although hypocalcaemia usually occurs soon after surgery, progressive atrophy of parathyroid glands can result in late presentation(2,3). Tingling sensation is a typical symptom of hypocalcemia absent in our case which suggests hypocalcemia may have gradually occurred over several months to years. Seizures in our patient which is another presentation of hypocalcemia occurring due to increased neuronal excitability. In our case, serum level of hypocalcemia was corrected within several days after calcium supplement. However restoration of LV systolic function and chamber size is being achieved in successive follow-up visits. CONCLUSIONS: Severe hypocalcemia in our case lead to seizures and DCMP associated with pleural effusion. This being a reversible aetiology should always be acknowledged specially in young patients with a history of total thyroidectomy. And this can be prevented by just calcium and Vitamin-D supplementation. REFERENCE #1: Bashour T. Bashn HS, Cheng TO. Hypocalcemia cardiomyopathy. Chest IY80; 78:663465. REFERENCE #2: Bringhurst FR. Calcium and phosphate distribution, turnover and metabolic actions. In: DeGroot LJ (ed) Endocrinology, 2nd Ed Philadelphia WB Saunders; 1989; 805-43. REFERENCE #3: Katz A. Pathophysiology of heart failure: Identifying targets for pharmacotherapy. Med Clin N Am 2003; 87:303-16. DISCLOSURES: No relevant relationships by Debasis Behera, source=Web Response No relevant relationships by AKASH DEEP, source=Web Response No relevant relationships by SUMAN JAGATY, source=Web Response No relevant relationships by Saswat Subhankar, source=Web Response" @default.
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• W3207641858 date "2021-10-01" @default.
• W3207641858 modified "2023-09-25" @default.
• W3207641858 title "PLEURAL EFFUSION AND SEIZURE: COINCIDENCE OR COEXISTENCE" @default.
• W3207641858 doi "https://doi.org/10.1016/j.chest.2021.07.1209" @default.
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