Endocrine Abstracts

A 25 year-old female Polytechnic student who presented at the emergency department with a 5-day history of high grade fever with chills and rigor, headache, generalized body weakness, postpandrial vomiting, epigastic pain and passage of melena and feeling of cramps in her hands and feet. Had no history of PUD but had used NSAIDS for pains and the cramps.

Her RBS was 155 mg/dl. Genotype unknown. LMP 6/4/17

Physical examination showed an acutely ill-looking lady, febrile (39.2°C), with demonstrable carpopedal spasms, not pale, anicteric, and had no pedal edema

Her pulse was irregular, of normal volume and the rate was 84/minute. The BP was 133/103 mmHg. Other systems were okay

She was treated as a case of acute severe malaria with hypocalcemic tetany and Upper GI Bleeding

She got better with 10% calcium gluconate infusion, anti-malarial and parenteral rabeprazole and her BP was 111/81 mmHg by next day. She was discharged after 5 days to the MOPD for follow up, on oral calcium supplements and rabeprazole

RESULTS: Total calcium – 1.37 (2.1 -–2.5)mmol/L (at admission)

Albumin – 30.05 (35 - 50)g/L

Magnesium – 0.86 (0.7 - 1.15)mmol/L

Phosphate – 1.89 (1.0 - 1.5)mmol/L

Total Calcium – 1.8 (2.1 - 2.5)mmol/L (next day after Ca gluconate infusion)

Total Calcium – 2.16 (2.1 - 2.6)mmol/L (5^th Day Of Admission [DOA])

Corrected calcium – 2.34 (2.1 - 2.6)mmol/L (5^th DOA)

Phosphate – 0.97 (0.8 - 1.4)mmol/L (5^th DOA)

The serum PTH urea, creatinine, electrolytes, CBC, TFT were normal. Serum vitamin D3 and calcitonin not done.

Abdominal and Neck USS – No parathyroid enlargement or abnormal abdominal findings

ECG findings – Sinus rhythm, atrial premature complexes, prolonged QTc