Bilateral vocal cord paralysis secondary to treatment of severe hypophosphatemia in a continuous ambulatory peritoneal dialysis patient.

Neuromuscular complications, including tetany and laryngeal spasm, are recognized complications of hypocalcemia and hypomagnesemia. We present a continuous ambulatory peritoneal dialysis patient with hypomagnesemia who developed hyperphosphatemia and profound hypocalcemia after oral phosphate replacement for severe hypophosphatemia. The combination of hypocalcemia and hypomagnesemia resulted in life-threatening bilateral vocal cord paralysis. Phosphate replacement should be determined and given cautiously, particularly in patients with renal failure and concomitant electrolyte disturbances.