Endocrine Abstracts

Introduction: Severe hypocalcemia is a life threatening condition, usually symptomatic with cardiovascular and neuromuscular manifestations. Varying clinical presentations and concomitant infections, however, might obscure the right diagnosis, delaying early treatment.

Case: A 51-year-old African male presents himself at the emergency department (ED) with complaints of a soar throat, a productive cough and a striking pinched voice. Investigation revealed a severe corrected hypocalcemia (0.97 mmol/l) with a prolonged QTc interval on ECG of 515 ms. We administered intravenous calcium at the ED, which instantly improved the quality of his voice. He was eventually diagnosed with primary hypoparathyroidism for which he has been treated with alfacalcidol and calcium suppletion and an upper airway infection as well.

Discussion: The hallmark of hypocalcemia is tetany. In spite of severe hypocalcemia, tetany was not the presenting symptom in our patient. Laryngospasm is rare to be the presenting symptom of hypocalcemia, especially without signs of overt tetany or seizures.

Failure to recognize hypocalcemia by interpreting the complaints to be caused by an upper airway infection can lead to discharging a patient at risk for serious complications like seizures, dysrythmias such as torsade de pointes and even cardiac arrest.

Conclusion: • Laryngospasm is a rare presenting symptom of hypocalcemia.

• In patients with nonspecific complaints of the throat and voice, laboratorium serum calcium and an ECG should be part of routine investigation in the ED.

• Concomitant infections might obscure the diagnosis of hypocalcemia.

• In case of severe hypocalcemia, calcium should instantly be administered intravenously in the ED.