Esomeprazole
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Hypocalcaemia and respiratory distress: case report A 50-year-old woman developed hypocalcaemia and respiratory distress during treatment with esomeprazole. The woman presented to a clinic with worsening dyspnoea. She became winded when going upstairs, a few weeks previously. Her airway was adequate at rest. Her medical history included follicular carcinoma of the thyroid, for which she underwent total thyroidectomy at the age of 16 years. She also had long-standing hypoparathyroidism and bilateral vocal fold paralysis. She underwent arytenoidectomy and vocal fold medialisation procedure for bilateral vocal fold paralysis more than 10 years previously. Her airway was not normal, but was stable and adequate for her activity level for many years. She received calcitriol and calcium for her long-standing hypoparathyroidism and hypocalcaemia for many years. Flexible laryngoscopy showed interarytenoid region was erythematous and oedematous, and mucus was stranding between the vocal processes. It was postulated that oedema from laryngopharyngeal reflux (LPR) was compromising her marginal airway. She then received a therapeutic trial with acid suppressive therapy, esomeprazole 40mg twice a day [route not stated]. On day 3 of treatment, she experienced parasthesias in her hands, which quickly evolved into respiratory distress with stridor. She was then taken to the emergency room and her ionised calcium level was found to be 0.8 mmol/L and total calcium level was 6.4 mg/dL. It was identified that esomeprazole was interfering with her calcium absorption. Her hypocalcaemia was treated with IV calcium and magnesium. Treatment with esomeprazole was discontinued. Her symptoms abated, with no recurrence of hypocalcaemia at the 1 year follow-up. Her airway was marginal, but adequate for most daily activities. Zaya NE, et al. Proton pump inhibitor suppression of calcium absorption presenting as respiratory distress in a patient with bilateral laryngeal paralysis and hypocalcemia. Ear, Nose, and Throat Journal 89: 78-80, No. 2, Feb 2010. Available from: URL: http://doi.org/10.1177/014556131008900209 803497125
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Reactions 22 Aug 2020 No. 1818
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