Alcohol, Confusion and Cramps

🗒️ Question

A 48-year-old man is brought to the Emergency Department by his partner due to confusion, weakness and muscle cramps. He has a long history of alcohol dependence and was recently treated for acute pancreatitis. His examination shows an irregular pulse of 110 bpm, blood pressure of 95/60 mmHg and mild abdominal tenderness.

His blood results are as follows:

• Sodium: 133 mmol/L (135–145)

• Potassium: 4.0 mmol/L (3.5–5.0)

• Calcium: 1.8 mmol/L (2.2–2.6)

• Phosphate: 0.5 mmol/L (0.8–1.5)

• Magnesium: 0.3 mmol/L (0.7–1.0)

What is the most likely cause of his current symptoms?

(A) Alcoholic ketoacidosis
(B) Hypocalcaemia secondary to pancreatitis
(C) Hypomagnesaemia secondary to chronic alcohol use
(D) Hyperparathyroidism
(E) Lactic acidosis due to alcohol withdrawal