We report an unusual case of
hypocalcemia and respiratory distress related to
acid-suppressive
therapy. The patient was a 50-year-old woman with bilateral
laryngeal paralysis and hypoparythyroidism resulting from a
thyroidectomy performed more than 30 years previously. She required large doses of
calcium supplementation to maintain a normal
calcium level. Her airway had been marginally adequate. A few weeks prior to presentation, she began to experience increasing
dyspnea. Examination was suggestive of
laryngopharyngeal reflux, and she was started on a therapeutic trial of
esomeprazole 40 mg twice daily. Three days later, she presented to the emergency room with airway distress. Laboratory studies indicated that the patient had
hypocalcemia. The
esomeprazole was discontinued, and she was treated with intravenous
calcium; her symptoms resolved. We attribute the airway distress to
tetany in synkinetically reinnervated laryngeal adductor muscles. We recommend that
acid-suppressive
therapy should be used with caution in patients with
hypoparathyroidism or
hypocalcemia.