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EMEDPA

cool metabolic case

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older guy with throat ca who has very limited diet and is on omeprazole(you will see why this is important in a minute...) presents with full body myalgias (requiring IV fentanyl and ativan for symptomatic control ) and muscle contractions. looks like caropedal spasms but not hyperventilating. drum roll please.....

lytes:

magnesium 0.5 (!!!)

Ca 5 (!)

K 2.5

all repleted IV with significant improvement within 1 hr. admitted to obs status for serial labs and repletion.

pro tip: omeprazole taken chronically depresses Mg levels.....not a great choice of med for someone on a limited diet.

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Geeze! Did you happen to get an ionized Ca++? I imagine he was pretty malnourished. Lowest I've seen was a post-thyroidecromy patient who came up post-op completely contracted, no idea how long she was in PACU, total Ca was around 4ish with an ionized of 0.38

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4 hours ago, MediMike said:

Geeze! Did you happen to get an ionized Ca++? I imagine he was pretty malnourished. Lowest I've seen was a post-thyroidecromy patient who came up post-op completely contracted, no idea how long she was in PACU, total Ca was around 4ish with an ionized of 0.38

the hospitalist probably did. 

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