“Footprinting” her diagnosis: hypocalcaemia-induced muscle contraction

A 46-year-old, previously healthy, female presented to the emergency department with severe abdominal pain. Physical examination showed spontaneous severe tetany of both her hands and feet. The feet of the patient pointed inand upwards toward her distended abdomen (Fig. 1). Her tetany was caused by severe hypocalcaemia due to acute biliary pancreatitis. Laboratory tests showed an ionized calcium concentration of 0.55 mmol/l (normal range 1.12–1.32), a total calcium level below 1.25 mmol/l (normal range 2.20–2.65) and a hypoalbuminaemia of 27 g/l (normal range 35–50). The raised parathyroid hormone level of 61 pmol/l (normal range 1.3–6.8) was secondary to her severe hypocalcaemia. The patient was rehydrated and intravenously treated with calcium gluconate. Her muscle contractions resolved completely in 3 days concomitant with the resolution of her electrolyte abnormalities. After a prolonged hospital stay the patient made a full recovery.