Asymptomatic Severe Hypocalcemia Secondary to Vitamin D Deficiency in an Elderly Patient

Abstract

Objective. To describe an asymptomatic presentation of severe hypocalcemia secondary to vitamin D deficiency in an elderly patient. Methods. We describe the presentation and clinical course of an elderly woman with asymptomatic severe hypocalcemia referred to an endocrinology clinic for hyperparathyroidism. Results. The patient is an 83-year-old Caucasian woman who presented to an endocrinology clinic for evaluation of hyperparathyroidism, with an intact PTH of 462 pg/mL (normal range 14–72 pg/mL). The same lab report included a serum calcium of 5.2 mg/dL (normal range 8–10.5 mg/dL). She displayed no signs or symptoms of hypocalcemia. Given the extreme severity of hypocalcemia and her age, she was hospitalized. Vitamin D deficiency was suspected and was subsequently confirmed with undetectable serum levels. The patient remained asymptomatic throughout her hospital stay. Total and ionized calcium levels at discharge were 7.2 mg/dL and 1.03 mmol/L (normal range 1.1–1.4 mmol/L), respectively. Conclusion. Physicians should exercise prudent management with respect to the vitamin D status of the elderly patient, as certain patients may exhibit severe hypovitaminosis D and hypocalcemia without apparent clinical symptoms.

Vitamin D levels and in-hospital mortality of COVID-19

“…Although vitamin D deficiency is known as a cause of hypocalcemia, severe calcium deficiency is rarely reported (31). No difference was observed between the Vit-D groups regarding corrected calcium levels in our study.…”

Hypocalcemia in Elderly Population in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

“… 2 Vitamin D deficiency, renal failure, and parathyroid hormone deficiency or resistances are the common culprits of hypocalcemia in elderly. 3 – 5 , 13 A study conducted by Suryanarayana et al found the prevalence of vitamin D deficiency to be 56.3% among elderly ≥ 60 years of age. 14 The activity of renal enzyme, 1-α hydroxylase, is responsible for formation of active vitamin D, which decreases with age leading to vitamin D deficiency and ultimately results hypocalcemia in elderly.…”

Influence of deficiency or insufficiency of vitamin D on the circadian rhythm of serum calcium level

“…Количество гипокальциемических эпизодов также уменьшается по мере достижения компенсации дефицита/недостаточности витамина D. В нашем исследовании у добровольцев определялась мягкая гипокальциемия, которая не сопровождалась появлением специфических симптомов (судороги, парестезии и др.). Необходимо отметить, что в литературе описаны клинические случаи выраженной гипокальциемии (<2 ммоль/л) на фоне резко сниженного уровня витамина D, которые также не приводили к развитию развернутой клинической картины [18].…”