BMJ Case Reports 2017; doi:10.1136/bcr-2017-222726
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Spontaneous bilateral carpopedal spasm in a bulimic patient

  1. Salik Nazir3
  1. 1Department of Internal Medicine, Reading Health System, Pennsylvania, USA
  2. 2Department of Internal Medicine, Reading Health System, Pennsylvania, USA
  3. 3Department of Internal Medicine, Reading Hospital and Medical Center, Pennsylvania, USA
  1. Correspondence to Dr Niranjan Tachamo, niranjantachamo{at}
  • Accepted 28 September 2017
  • Published 9 October 2017


A 36-year-old woman presented to the emergency department after she woke up with painful spasm of bilateral hands. She had been vomiting 10–15 times daily for the past few days. She denied any laxative or diuretic abuse. She had 18-year history of bulimia nervosa, primarily involving self-induced vomiting and excessive exercising. Her body mass index was 20.7 kg/m2. Vital signs and physical examination were unremarkable except for dry oral mucosa, poor oral dentition and classic bilateral carpopedal spasm (figure 1). Labs revealed hypocalcaemia (ionised calcium 0.88 mmol/L), hypokalaemia (potassium 2.8 mEq/L), hypomagnesaemia (magnesium 1.6 mEq/L), metabolic alkalosis (serum …

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