{"id":20454,"date":"2026-07-31T10:32:54","date_gmt":"2026-07-31T10:32:54","guid":{"rendered":"https:\/\/woncaeurope2026.org\/sessions\/looking-for-the-culprit-a-case-of-hard-detective-work-to-reach-the-correct-diagnosis\/"},"modified":"2026-07-31T10:32:54","modified_gmt":"2026-07-31T10:32:54","slug":"looking-for-the-culprit-a-case-of-hard-detective-work-to-reach-the-correct-diagnosis","status":"publish","type":"wsa_session","link":"https:\/\/woncaeurope2026.org\/fr\/sessions\/looking-for-the-culprit-a-case-of-hard-detective-work-to-reach-the-correct-diagnosis\/","title":{"rendered":"Looking for the culprit, a case of hard &#8220;detective work&#8221; to reach the correct diagnosis"},"content":{"rendered":"<p>Case report of an unusual cause of severe hypocalcemiaData extracted from patient\u00b4s elctronic medical records. 64-year-old male patient, smoker, diagnosed with high blood pressure(HBP), rheumatoid arthritis(RA), hiperuricemia, gastroesophageal reflux disease(GERD), on chronic treatment with olmesartan\/hydrochlorotiazide 40\/12,5mg, lorazepam 1mg, methotrexate 15mg, adalimumab, paracetamole\/tramadol 650\/75mg and omeprazole 40mg, sometimes prednisone added for acute pain. Followed-up by rheumatologyst for his RA. In a general check-up with the family doctor he complainted of 2,5-month duration paresthesias. One week later he experienced uncounsciousness and seizures, sphincter relaxation and amnesia of the episode. The emergency service referred him to hospital, where the initial blood tests were normal except for very low blood calcium, cerebral CTscan normal. He was admitted to internal medicine department.\u00a0He responded to intravenous calcium, but still presenting dizziness.\u00a0Then low blood magnesium was also found and the patient responded well to intravenous Mg treatment.\u00a0 Reviewing his treatment, the initial doubt was addressed to adalimumab, which could be responsible for the severe hypocalcemia, but not for the hypomagnesemia. Eventually, the &quot;winner to blame&quot; was omeprazole, as it can produce low magnesium levels with chronic treatments. The final diagnosis at release was severe hypocalcemia secondary to hypomagnesemia due to chronic use of omeprazole. The patient maintained stability, with no new complaint. Omeprazole and adalimumab were withdrawn and replaced with famotidine, calcium and vitamine D. The patient has a follow up booking within two months.I bring this case into discussion because it was difficult to get to the correct diagnosis and because the treatment with omeprazole is very common, although this side effect is very rare, as the bibliographic research showed eventually.Although we oftenly use chronic PPI treatments, we should keep in mind that iatrogenesis could be responsible for severe conditions.Polymedicated patients are at risk of lots of interactions and side-effects of their &quot;drug cocktail&quot;, difficult to figure out sometimes.Even if a patient is on a relatively new treatment line (e.g. biological treatments), their complaints might not be due to it, although it\u00b4s our first thought. It\u00b4s very important to constantly review chronic treatments, especially when new complaints come across.<\/p>\n","protected":false},"template":"","class_list":["post-20454","wsa_session","type-wsa_session","status-publish","hentry","description-off"],"_links":{"self":[{"href":"https:\/\/woncaeurope2026.org\/fr\/wp-json\/wp\/v2\/wsa_session\/20454","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/woncaeurope2026.org\/fr\/wp-json\/wp\/v2\/wsa_session"}],"about":[{"href":"https:\/\/woncaeurope2026.org\/fr\/wp-json\/wp\/v2\/types\/wsa_session"}],"wp:attachment":[{"href":"https:\/\/woncaeurope2026.org\/fr\/wp-json\/wp\/v2\/media?parent=20454"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}