Thanks to everyone who was prepared to rack their brains on behalf of
our mystery patient, a young man with hypocalcemia, fluctuating
calcium levels and heart rhythm disturbances.
Reactions varied: just without reference limits, so probably
normal, measure Hb (9.4 mmol/L) and anti-gliadin (no suspection
of celiac disease), Mg (0.85 mmol/L), analytical problems despite
good QC results (this collegue had seen several of these patients),
to decreased binding of calcium to albumin (e.g. increased FFA), or a
genetic variant of albumin. The most spectacular comment was a
suggestion of Munchhausen syndrome: the patient taking EDTA which
causes low calcium in some assays.
We still think something might be found because the GP sent this
patient to our hospital on a calcium of 2.09 mmol/L (no albumin
measured). Drug history unknown. We have no definitive diagnosis but
when anything turns up, I will let you know.
Best wishes
Raymond Wulkan
Zuiderziekenhuis
Rotterdam
The Netherlands
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