Hypocalcemic convulsions secondary to hypomagnesemia; a case report

Abstract

Hypomagnesemia with secondary hypocalcemia (HSH) is a rare inherited disorder, characterized by low levels of serum magnesium associated with symptomatic hypocalcemia. This condition manifests with the defect in the intestinal trans-epithelial transport system-defective intestinal absorption of magnesium, which impairs the function of the parathyroid gland. The condition typically presents in the infancy with neuromuscular excitability and convulsion refractory to antiepileptic therapy. We described a 2-yearold patient presented with generalized tonic convulsions refractory to antiepileptic therapy. The clinical examination demonstrated stiffening of hands and feet. The laboratory investigations showed severe hypomagnesemia with associated hypocalcemia. Parathyroid hormone level was in the lower normal range (25 pg/mL). Based on the presentation and laboratory findings, magnesium sulphate intravenous (IV) and calcium (oral + I.V.) replacement therapy was initiated. Parathyroid hormone level normalized and symptoms resolved. Magnesium levels should always be investigated while confirming the etiologic basis for seizures. Early diagnosis and prompt magnesium replacement are essential to prevent death or long-term irreversible neurologic damage.

Keywords: Hypomagnesemia, Hypocalcemia, Convulsions