Hypocalcemia: An Unusual Presentation: Case Report

Calcium is among the top three ions in the body and plays an important role in maintaining normal cellular function, intracellular signaling, blood coagulation, neural transmission, and integrity of the bone structure. Endocrine disorders have long been known to present with various neuropsychiatric manifestations. We aim to show how hypocalcemia can present acutely as delirium without any other symptoms. We focus our attention on hypocalcemia as a rare cause of delirium and psychosis as this is more commonly seen in hypercalcemia. We present a case of a 71-year-old patient with psychosis and delirium following an acute drop in calcium levels and review the existing literature. The relationship between calcium metabolism and psychiatric disturbances is poorly understood. There are few published reports of neuropsychiatric manifestations in hypocalcemia and most are due to bisphosphonates use which was not the case in our patient. She also had no other symptoms of hypocalcemia. Hypocalcemia may present acutely with only a change in mental status and without any of the classic symptoms of numbness, tingling, or paresthesia. This is a rare presentation of this abnormality and a high index of suspicion is needed for prompt management.