Proton pump inhibitor suppression of calcium absorption presenting as respiratory distress in a patient with bilateral laryngeal paralysis and hypocalcemia.
We report an unusual case of hypocalcemia and respiratory distress related to acid-suppressive therapy. The patient was a 50-year-old woman with bilateral laryngeal paralysis and hypoparythyroidism resulting from a thyroidectomy performed more than 30 years previously. She required large doses of calcium supplementation to maintain a normal calcium level. Her airway had been marginally adequate. A few weeks prior to presentation, she began to experience increasing dyspnea. Examination was suggestive of laryngopharyngeal reflux, and she was started on a therapeutic trial of esomeprazole 40 mg twice daily. Three days later, she presented to the emergency room with airway distress. Laboratory studies indicated that the patient had hypocalcemia. The esomeprazole was discontinued, and she was treated with intravenous calcium; her symptoms resolved. We attribute the airway distress to tetany in synkinetically reinnervated laryngeal adductor muscles. We recommend that acid-suppressive therapy should be used with caution in patients with hypoparathyroidism or hypocalcemia.
Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL 62794-9662, USA.
Ninef E
NE
Zaya
Gayle
G
Woodson
D002117:Calcitriol / Q000627:therapeutic use; D002118:Calcium / Q000037:antagonists & inhibitors* / Q000378:metabolism* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000150:complications* / Q000188:drug therapy; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000494:pharmacology*; D012131:Respiratory Insufficiency / Q000139:chemically induced / Q000150:complications / Q000175:diagnosis; D012720:Severity of Illness Index; D014826:Vocal Cord Paralysis / Q000150:complications* / Q000175:diagnosis
D054328:Proton Pump Inhibitors; D002117:Calcitriol; D002118:Calcium