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Background <p>Hypocalcaemia-induced laryngospasm is a rare but life-threatening cause of upper airway obstruction. Management is particularly challenging in resource-limited settings due to delayed laboratory results, limited monitoring, and unavailability of preferred medications.</p> Case presentation <p>A 20-year-old previously healthy woman presented with severe stridor, respiratory distress, and carpopedal spasm. Laboratory findings (obtained after initial treatment) revealed ionized calcium 0.9 mmol/L (reference range: 1.12–1.32 mmol/L), magnesium 1.6&#xa0;mg/dL (reference range: 1.7–2.3 mg/dL), and severe vitamin D deficiency (25-hydroxyvitamin D 11.83 ng/mL; severe deficiency &lt; 10–12 ng/mL). Despite aggressive intravenous calcium gluconate boluses (2&#xa0;g × 4 additional doses after initial), continuous infusion (up to 2&#xa0;mg/kg/h), and magnesium replacement, laryngospasm progressed to complete airway obstruction with desaturation to 70%. Emergency rapid sequence intubation was performed with ketamine 100&#xa0;mg (2.5&#xa0;mg/kg) and vecuronium 4&#xa0;mg. Because calcitriol was unavailable, intramuscular cholecalciferol 50,000 IU was administered as off-label loading. The patient was extubated after 72&#xa0;hours and discharged after 8 days with normalized levels on continued cholecalciferol therapy.</p> Conclusions <p>Favourable outcomes can be achieved in resource-limited emergency departments through clinically guided aggressive therapy, timely airway intervention, and pragmatic use of available long-acting vitamin D when preferred agents are inaccessible. This underscores the value of adaptable strategies in low-resource settings.</p>

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Refractory hypocalcaemia-induced laryngeal spasm requiring emergency intubation in a malnourished young woman: overcoming diagnostic and therapeutic barriers in resource-limited settings

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月15日

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  • Ayto A. Negash,
  • Mehreteab T. Woudineh,
  • Yitayew E. Mohammed,
  • Eyob Z. Chafamo,
  • Solomon Y. Tilahun,
  • Petros T. Mekuria,
  • Tekiy M. Bedore,
  • Ashagre E. Hundeto

摘要

Background

Hypocalcaemia-induced laryngospasm is a rare but life-threatening cause of upper airway obstruction. Management is particularly challenging in resource-limited settings due to delayed laboratory results, limited monitoring, and unavailability of preferred medications.

Case presentation

A 20-year-old previously healthy woman presented with severe stridor, respiratory distress, and carpopedal spasm. Laboratory findings (obtained after initial treatment) revealed ionized calcium 0.9 mmol/L (reference range: 1.12–1.32 mmol/L), magnesium 1.6 mg/dL (reference range: 1.7–2.3 mg/dL), and severe vitamin D deficiency (25-hydroxyvitamin D 11.83 ng/mL; severe deficiency < 10–12 ng/mL). Despite aggressive intravenous calcium gluconate boluses (2 g × 4 additional doses after initial), continuous infusion (up to 2 mg/kg/h), and magnesium replacement, laryngospasm progressed to complete airway obstruction with desaturation to 70%. Emergency rapid sequence intubation was performed with ketamine 100 mg (2.5 mg/kg) and vecuronium 4 mg. Because calcitriol was unavailable, intramuscular cholecalciferol 50,000 IU was administered as off-label loading. The patient was extubated after 72 hours and discharged after 8 days with normalized levels on continued cholecalciferol therapy.

Conclusions

Favourable outcomes can be achieved in resource-limited emergency departments through clinically guided aggressive therapy, timely airway intervention, and pragmatic use of available long-acting vitamin D when preferred agents are inaccessible. This underscores the value of adaptable strategies in low-resource settings.