An alcoholic patient with low calcium has a hypocalcemia that does not respond to calcium supplementation. What is the most likely associated factor?

• A. Hypoparathyroidism due to autoimmune destruction.
• B. Vitamin D deficiency causing poor calcium absorption.
• C. Chronic kidney disease reducing calcium reabsorption.
• D. Alcoholism causing hypomagnesemia leading to hypocalcemia refractory to supplementation.

Answer: (D)