A case of acute, severe and symptomatic hypocalcaemia: lessons for patients on the AAU

The case is reported of a 77 year old lady admitted with sepsis, hypotension, lactic acidosis and acute kidney injury from an uncertain origin. She had a background of myeloma which had been treated 18 months earlier and had been continued on the bisphosphonate clodronate. Sepsis was empirically treated with gentamicin, benzyl-penicillin and metronidazole. On day 4 of admission she was noted to be severely hypocalcaemic and hypomagnesaemic, which improved after the oral bisphosphonate was stopped and calcium supplementation administered.