Tetany Secondary to the Use of a Proton-Pump Inhibitor

Vishakalakshmi Subbiah; John A. Tayek

doi:10.7326/0003-4819-137-3-200208060-00024

Letters |6 August 2002

Tetany Secondary to the Use of a Proton-Pump Inhibitor

Vishakalakshmi Subbiah, MBBS; John A. Tayek, MS, MD

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TO THE EDITOR:

Calcium is well absorbed in the presence of acid, but absorption is decreased by 80% in patients with achlorhydria (1). Six years after near total thyroidectomy, a 46-year-old woman presented to her primary care physician with symptoms of heartburn. Gastroesophageal reflux disease was diagnosed, and the patient was prescribed ranitidine, 150 mg orally twice per day. After 3 months of persistent gastroesophageal reflux disease, her symptoms were relieved with a proton-pump inhibitor (lansoprazole, 30 mg).

Approximately 2 weeks after treatment with the proton-pump inhibitor, the patient reported numbness, chest pressure, and muscle cramping in the hands and feet while driving a car. Within 2 weeks, she presented to the emergency department with symptoms of severe muscle cramping. Physical examination showed severe cramping in her hands, jaw, and left foot, with a positive Chvostek sign. Ionized calcium level was reduced at 0.83 mmol/L (3.31 mg/dL) (reference range, 1.17 to 1.33 mmol/L [4.68 to 5.30 mg/dL]). Levels of total calcium, parathyroid hormone, and thyroid-stimulating hormone were reduced, and vitamin D status was normal (Table).

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2002 American College of Physicians

Letters |6 August 2002

Tetany Secondary to the Use of a Proton-Pump Inhibitor

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Letters |6 August 2002

Tetany Secondary to the Use of a Proton-Pump Inhibitor

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