The patient whose hypocalcaemia worsened after prompt intravenous calcium replacement therapy

As a junior in the emergency department, I saw a 30-year-old man with severe numbness, tingling in the fingers and toes and perioral area, muscle cramps, and tetany; he had chronic hypoparathyroidism, due to thyroidectomy, which was being treated with oral replacement of thyroid hormones, calcium, and vitamin D. He had been unable to take his regular treatment over the past few weeks because of gastroenteritis. Blood tests showed a low total calcium of 1·125 mmol/L (free ionised portion 0·51 mmo ..