Hypoalbuminaemia associated hypocalcaemia with overt clinical features: A case report

Abstract

Hypocalcaemia is defined as serum calcium level less than 9.0 mg/100 ml (2.25 Mmol/l). It is often only being considered as a differential diagnosis in the paediatric unit, where it is usually included as part of routine investigations, especially in children with clinical problems such as convulsions, seizure, apathy, muscles weakness, tetany, suspected vitamin D deficiency or maternal hypercalcaemia. In adult patients however, hypocalcaemia is often neglected (especially in private health facilities) except in specialties such as rheumatology, neurology, nephrology and intensive care unit. In this report, neurological manifestations (paraesthesia, delirium, seizure and coma) were presented by the patient. Both anthropometric and biochemical parameters were evaluated in this patient and the results were used to evaluate the patients clinical presentation. The findings revealed that there was malnutrition, which manifested biochemically as hypoalbuminaemia and hypocalcaemia. Calcium replacement therapy satisfactorily returned this patient to stable clinical state, the therapy was done parenterally but gradually. Surprisingly, this patient showed overt clinical features of hypocalcaemia against the popular belief that hypoalbumineamic hypocalcaemia does not have a physiological significance. This report emphasizes the need to include serum calcium estimations in our routine investigations in clinical practice on one hand, and on the other hand, it appears to disagree with the overemphasized rarity of physiologically significant hypocalcaemia due to hypoalbuminaemia. Key words: Hypocalcaemia, hypoalbuminaemia, overt clinical features.