Regarding the interesting case of the hypocalcaemia in the 30 year-old
woman with normal albumin, normal magnesium, bordlerine high ionised
calcium and low to low-normal PTH.
While I have not seen such a case my thoughts turn to abnormal calcium
binding to albumin. The range of possibilities could include an abnormal
albumin (an EPG may show something), chronic acidosis (I assume the HCO3 is
normal), or something displacing the calcium. The clinical findings of
hypocalcaemia are generally not fits but more commonly include carpo-pedal
spasm and per-oral parasthesia (is there any history of these?).
In terms of managing the patient I would follow the ionised more closely
than the total calcium even if no cause can be identified.
I would be interested in any progress.
Good luck,
Graham Jones
Staff Specialist in Chemical Pathology
St Vincent's Hospital, Sydney
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