Hypocalcemia in a 15 Year Old With New Onset Type 2 Diabetes Mellitus

Abstract Background: Diabetic ketoacidosis and significant hyperglycemia are associated with known electrolyte derangements in sodium, potassium, phosphorus. Hypocalcemia hypoparathyroidism occurring uncontrolled diabetes rare. We present a case of new-onset severe hypocalcemia. Case: A 15-year-old obese Caucasian male ADHD autism presented to the Emergency room due found on laboratory evaluation for hypertension. Serum glucose was 563 mg/dL, serum bicarbonate 24 meq/L (21 - 31 meq/L), HgbA1C 11.4% (4.0 5.6%). He admitted initiate insulin education. On admission, hypocalcemia noted: calcium 6.6 mg/dL (8.5 10.5 mg/dL), alkaline phosphatase 352 units/L (48 277 units/L), albumin 4.6 g/dL (3.5 5.0 g/dL). Repeat testing revealed 5.1 phosphorus 4.3 (2.5 4.5 magnesium 1.7 (1.6 2.9 mg/dL). endorsed 2 month history tetany, paresthesia, muscle weakness. Due food aversions, his dietary intake vitamin D minimal. had limited sun exposure. Subsequent PTH 40 pg/mL (10 65 pg/mL) concurrent 6.5 mg/dL. QTc prolonged [529 msec (<440 msec)], prompting transfer intensive care unit telemetry, intravenous gluconate, regular monitoring. Treatment commenced cholecalciferol 2000 international units daily oral carbonate (50 mg elemental calcium/kg/day) divided doses presumed Vitamin deficiency. After several gluconate over hours, patient’s ionized normalized. At discharge, 8.5 discharged above regimen cholecalciferol, basal bolus insulin. results returned indicating negative autoantibodies (GAD 65, Insulin, IA-2) 25-OH <10 ng/mL (30 100ng/mL). Two days after 7.3 weeks later, labs were: 11.3 ng/mL, 10.4 pg/mL, 9.6 Conclusion: This teen type symptomatic hypocalcemia, an atypical feature diabetes. likely both deficiency hypoparathyroidism. low level poor elevated phosphatase; however, high normal inappropriately (instead setting hypocalcemia) indicated component Calcium normalized detectable levels but remained low. Our highlights importance recognizing that abnormalities at onset may not be directly attributable diabetes/hyperglycemia co-exist.