This case report describes an elderly lady who was maintained on a high dose of loop diuretics following resolution of her acute pulmonary oedema, which in turn led to wasting of calcium and magnesium at the nephron level. Her hypomagnesaemia further contributed to the hypocalcaemia by rendering ineffective the normal parathyroid negative feedback physiological response. This state of low calcium increased the neuromuscular excitability leading to myoclonic epilepsy which was resistant to benzodiazepines. Such hypocalcaemic tetany in this case would only be adequately addressed once the magnesium levels are repleted, as this would allow the parathyroid mechanism to function effectively and redress the calcium level as a result.
Treatment of refractory vasospastic angina complicated by acute pulmonary oedema with levosimendan: a case report