Background: 28 days old baby girl presented to ER with seizure like activity for the last two weeks, breast feeding well and thriving. Past history full term normal delivery, no neonatal complications and no maternal history apart from iron deficiency anemia. Case presentation summary: Examination unremarkable, vitals and sugar were stable intermittent jerky movements of the limbs with no stiffness. Investigations: calcium 7.4 mg/dL, Magnesuim (Mg) 0.52 mg/dL, phosphate 8.3 mg/dL, glucose 90 mg/dl.alkpo4 raised and iPth normal. The bay was initially treated with a loading dose of phenobarbitone and oral calcium. Within 24 hours the serum calcium starts normalizing. The Mg level remained below normal. Serum 25 hydroxyl vitamin D reported less then 12 ng/ml urinary electrolytes were in the normal ranges renal and cranial ultrasounds reported normal metabolic and genetic studies were in progress Maternal vitamin D reported less then 8 ng/ml. Within 24 hours the seizures stopped serum calcium including the ionized calcium and phosphate levels starts normalizing, the Mg level still low and a mild response to a state dose of magnesuim. The baby was started on the third of the treatment with cholecalciferol and the magnisuim starts normalizing.The mother was started on vitamin D.
Conclusion/Learning points: This case of hypocalcemia secondary to maternal vitamin D deficiency responded to oral calcium supplements, the Magnesuim starts normalizing after starting the baby on cholecalciferol. The magnesuim levels were not responding to calcium and bolus dose of magnesuim. The vitamin D was started on the third day of treatment because of the risk of bone resorption.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology