Abstract: PUB096
Severe Hypocalcemia Due to a Highly Restricted Vegan Diet
Session Information
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Dehmami, Farbod, Methodist Dallas Medical Center, Dallas, Texas, United States
- Goycochea, Carlos J., Methodist Dallas Medical Center, Dallas, Texas, United States
- Collazo-Maldonado, Roberto L., Methodist Dallas Medical Center, Dallas, Texas, United States
Introduction
Vegetarian diets have been adopted since antiquity for ethical or philosophical reasons and as part of religious commitments. Increasing attention has been given to the associated health benefits of the vegetarian diet. However, vegans are particularly susceptible to lower intake of micronutrients including calcium and vitamin D. [1-4]
Case Description
A 31-year-old AA man with no prior medical history presented with 2 days of paresthesias and grip difficulty. He followed a strict vegan diet for 7 years without supplementation and reported minimal sunlight exposure. V/S were stable, with decreased reflexes on exam. Admission labs revealed severe hypocalcemia (5.0 mg/dL), PTH (560 pg/mL), ionized Ca (0.74 mmol/L), albumin (5.1 g/dL), phosphorus (4.2 mg/dL) and profound vitamin D deficiency (<4 ng/mL), with normal magnesium and kidney function. EKG with QTc 419 ms. The patient was treated with intravenous calcium gluconate (12 g total) and cholecalciferol, with normalization of calcium by discharge (8.2 mg/dL) and resolution of symptoms in 72 hours.
Discussion
This case demonstrates the dangers of following a highly vegan diet presenting as severe hypocalcemia due to vitamin D deficiency in the setting of a highly restrictive vegan diet compounded by limited sunlight exposure. While most individuals following vegan diets maintain eucalcemia through compensatory secondary hyperparathyroidism, prolonged and profound deficiency can overwhelm these mechanisms, resulting in life-threatening hypocalcemia.