A Case of Severe Hypocalcemia Caused by Malabsorption Due to Partial Gastrectomy and Small Bowel Resection.
A Case of Severe Hypocalcemia Caused by Malabsorption Due to Partial Gastrectomy and Small Bowel Resection.
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DOI：
10.1016/j.aace.2021.04.002
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发表时间：
2021-09
影响因子：
--
通讯作者：
Vellanki P
中科院分区：
文献类型：
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作者：
Knight JO;Cotten LF;Ziegler TR;Vellanki P
钙是一种重要的矿物质，参与几乎每个人体细胞的功能。钙水平受膳食吸收、维生素 D 状态和甲状旁腺激素 (PTH) 的调节。该报告描述了一名儿童期肠切除和部分胃切除导致成年后吸收不良性低钙血症的患者。一名 21 岁男子因晕厥和跌倒导致右股骨颈骨折。他的病史包括 9 岁时因小肠梗阻需要肠切除术，以及 12 岁时因胃穿孔和部分胃切除术。实验室值显示钙水平为 4.9 mg/dL (8.9-10.3 mg/dL)。 PTH 水平为 273 pg/mL (12.0-88.0 pg/mL)，25-羟基维生素 D 为 28 ng/dL (30-100 ng/mL)，1,25-二羟基维生素 D 为 54 pg/dL (18-72 pg/mL)。此外，镁和磷的水平分别为 2.1 mg/dL (1.5-2.6 mg/dL) 和 4.4 mg/dL (2.4-4.7 mg/dL)。 10%葡萄糖酸钙滴注后，钙水平提高至 9.5 mg/dL，但口服碳酸钙补充剂无法将钙水平维持在 7 mg/dL 以上，尽管剂量高达 3750 mg，每日三次，骨化三醇 0.75 mcg，每日两次。从碳酸钙改为柠檬酸钙 3500 mg，每日 3 次后，钙水平得到改善并维持在 8.3 至 9.0 mg/dL 之间。高钙需求、其他营养缺乏以及对柠檬酸钙与碳酸钙的反应表明胃酸缺乏和小肠切除引起的吸收不良。该病例强调了钙稳态中的胃肠道生理学，并强调了低钙血症是胃和肠切除术并发症的认识。
Calcium is an essential mineral involved in the functioning of nearly every human cell. Calcium levels are regulated by dietary absorption, vitamin D status, and parathyroid hormone (PTH). This report describes a patient in whom childhood bowel resection and partial gastrectomy resulted in malabsorptive hypocalcemia in adulthood. A 21-year-old man presented with syncope and a fall resulting in a right femoral neck fracture. His medical history included small bowel obstructions at age 9 requiring bowel resection, and at age 12 with gastric perforation and partial gastrectomy. Laboratory values showed calcium level of 4.9 mg/dL (8.9-10.3 mg/dL). PTH level was 273 pg/mL (12.0-88.0 pg/mL), 25-hydroxy-vitamin D was 28 ng/dL (30-100 ng/mL), and 1,25-dihydroxy-vitamin D was 54 pg/dL (18-72 pg/mL). Furthermore, magnesium and phosphorus levels were 2.1 mg/dL (1.5-2.6 mg/dL) and 4.4 mg/dL (2.4-4.7 mg/dL), respectively. Calcium levels improved to 9.5 mg/dL on 10% calcium gluconate drip but could not be maintained above 7 mg/dL on oral calcium carbonate supplementation, despite doses as high as 3750 mg three times daily with calcitriol 0.75 mcg twice daily. After switching from calcium carbonate to calcium citrate 3500 mg three times daily, the calcium level improved and was maintained between 8.3 and 9.0 mg/dL. High calcium needs, other nutrient deficiencies, and response to calcium citrate versus calcium carbonate suggest malabsorption from achlorhydria and small bowel resection. This case emphasizes the gastrointestinal physiology in calcium homeostasis and highlights the recognition of hypocalcemia as a complication of gastric and bowel resection.