Sofiya Milman1, Eric J Epstein. 1. Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Montefiore Medical Center, Bronx, New York 10467, USA. smilman@montefiore.org
Abstract
OBJECTIVE: To report a case of proton pump inhibitor-induced hypocalcemic seizure in a patient with hypoparathyroidism. METHODS: We describe the clinical history, physical examination findings, and laboratory values of the patient and briefly review the relevant literature. RESULTS: A 48-year-old woman with a history of postsurgical hypoparathyroidism who was taking calcium carbonate, 1500 mg 3 times daily, and cholecalciferol, 1200 IU daily, presented with a generalized seizure in the setting of hypocalcemia 12 days after initiating therapy with the proton pump inhibitor lansoprazole. Physical examination revealed a positive Chvostek sign. Electrocardiogram was notable for a prolonged QT(c) interval of 576 milliseconds. Laboratory data were notable for the following values: total serum calcium, 5.3 mg/dL; ionized calcium, 2.51 mg/dL; and intact parathyroid hormone, 5.8 pg/mL. The patient's condition responded to therapy with intravenous calcium gluconate, oral calcium carbonate, and calcitriol. As an outpatient she remained asymptomatic off lansoprazole, treated with calcium carbonate and calcitriol. CONCLUSIONS: Caution should be exercised in prescribing proton pump inhibitors to patients with a history of hypoparathyroidism treated with calcium carbonate supplementation because severe hypocalcemia is a potential adverse effect.
OBJECTIVE: To report a case of proton pump inhibitor-induced hypocalcemic seizure in a patient with hypoparathyroidism. METHODS: We describe the clinical history, physical examination findings, and laboratory values of the patient and briefly review the relevant literature. RESULTS: A 48-year-old woman with a history of postsurgical hypoparathyroidism who was taking calcium carbonate, 1500 mg 3 times daily, and cholecalciferol, 1200 IU daily, presented with a generalized seizure in the setting of hypocalcemia 12 days after initiating therapy with the proton pump inhibitor lansoprazole. Physical examination revealed a positive Chvostek sign. Electrocardiogram was notable for a prolonged QT(c) interval of 576 milliseconds. Laboratory data were notable for the following values: total serum calcium, 5.3 mg/dL; ionizedcalcium, 2.51 mg/dL; and intact parathyroid hormone, 5.8 pg/mL. The patient's condition responded to therapy with intravenous calcium gluconate, oral calcium carbonate, and calcitriol. As an outpatient she remained asymptomatic off lansoprazole, treated with calcium carbonate and calcitriol. CONCLUSIONS: Caution should be exercised in prescribing proton pump inhibitors to patients with a history of hypoparathyroidism treated with calcium carbonate supplementation because severe hypocalcemia is a potential adverse effect.
Authors: John P Bilezikian; Aliya Khan; John T Potts; Maria Luisa Brandi; Bart L Clarke; Dolores Shoback; Harald Jüppner; Pierre D'Amour; John Fox; Lars Rejnmark; Leif Mosekilde; Mishaela R Rubin; David Dempster; Rachel Gafni; Michael T Collins; Jim Sliney; James Sanders Journal: J Bone Miner Res Date: 2011-10 Impact factor: 6.741
Authors: John P Bilezikian; Maria Luisa Brandi; Natalie E Cusano; Michael Mannstadt; Lars Rejnmark; René Rizzoli; Mishaela R Rubin; Karen K Winer; Uri A Liberman; John T Potts Journal: J Clin Endocrinol Metab Date: 2016-03-03 Impact factor: 5.958