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• W4280496932 abstract "Calcium homeostasis depends on multiple factors including absorption, renal function, parathyroid hormone (PTH), vitamin D, phosphate and magnesium. Hypocalcemia may be classified as PTH dependent or independent. Hypocalcemia with low PTH is seen when parathyroid glands are compromised, most commonly due to surgery, but also due to autoimmune, congenital and genetic conditions. Hypocalcemia with high PTH is seen in vitamin D deficiency, chronic kidney disease (CKD), and several other conditions. Hypomagnesemia also contributes to hypocalcemia without increase in PTH levels. We present a case of a patient with hypocalcemia to highlight that several etiologies may be concurrently involved in producing hypocalcemia, demonstrating the importance of taking a good social history in addition to a variety of diagnostic studies in the workup of such a patient. A 70 year old female with hypertension, hyperlipidemia, type 2diabetes mellitus, carotid artery stenosis, and peripheral arterial disease was seen for an annual physical. Medications included amlodipine, atorvastatin, losartan and pantoprazole. She was asymptomatic at the time of the exam. Laboratory testing revealed: calcium 6.9 mg/dL, albumin 4.3 g/dL, PTH 61 pg/mL, vitamin D 7.5 ng/mL, magnesium 0.4 mg/dL and eGFR of 40 ml/min. Upon further questioning, the patient admitted to consuming three to four glasses of vodka with fruit juice per day. Vitamin D and magnesium replacement were initiated and the patient was counseled on alcohol cessation, but was lost to follow up. We could consider many etiologies for hypocalcemia in our patient including CKD, vitamin D deficiency, malnutrition and hypomagnesemia. Vitamin D deficiency causes hypocalcemia by reducing absorption of calcium in the gut. Hypomagnesemia appears to be multifactorial from chronic proton pump inhibitor (PPI) therapy, CKD, and poor nutrition (seen in chronic alcohol use disorder patients). There have also been studies which show how patients with chronic alcohol use disorder develop hypomagnesemia, due to impaired handling of magnesium by the kidneys, with inappropriately high magnesium excretion. Alcohol use disorder patients should be counseled for alcohol cessation, and also frequently monitored for electrolyte abnormalities such as calcium and magnesium in order to prevent inadvertent hospitalizations. This case helps us understand the various mechanisms involved in hypocalcemia due to multiple causes." @default.
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• W4280496932 date "2022-05-01" @default.
• W4280496932 modified "2023-09-29" @default.
• W4280496932 title "Abstract #1182865: Hypocalcemia Induced by Both Hypomagnesemia and Vitamin D Deficiency in a Woman with Covert Alcohol Use Disorder" @default.
• W4280496932 doi "https://doi.org/10.1016/j.eprac.2022.03.216" @default.
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