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An electrolyte disturbance masquerading as a panic attack.

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January 2025

Anne Wildermuth is an assistant professor in the School of Medicine at the Uniformed Services University in Bethesda, Md., and practices in emergency medicine with MedStar Emergency Physicians in Clinton, Md. At the time this article was written, Meagan Lantz and Erin Sagers were students in the PA program at the George Washington University in Washington, D.C. Ms. Lantz now practices in cardiothoracic surgery at Stanford Health Care in Palo Alto, Calif. Ms. Sagers now practices in orthopedics at EmergeOrtho Coastal Region in Wilmington, N.C. The authors have disclosed no potential conflicts of interest, financial or otherwise. The views expressed in this article are those of the authors and not of the Department of Defense, Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., or other federal agencies.

Because proton pump inhibitors (PPIs) are so commonly used, their safety and potential adverse reactions often are not considered. This article describes a patient whose paresthesias and severe muscle cramps were attributed to panic attacks but actually were caused by hypocalcemia secondary to PPI-induced hypomagnesemia. This case serves as a reminder that PPIs should be used cautiously and appropriately with consideration for regular monitoring of electrolytes and vitamin B12.

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