Profile of the causes of symptomatizing hypocalcemia in infants and children

Abstract

Background Symptomatizing hypocalcemia is defined as reduction in the level of ionized calcium in the blood to less than 0.95 mmol/l, associated with obvious manifestations such as neuromuscular impairment in the form of convulsion, carpopedal spasm, paresthesia or stridor, etc. Calcium hemostasis, to keep the level of calcium maintained at normal level, is controlled by normal nutritional intake of vitamin D and calcium-containing foods, by normal calcium and vitamin D absorption from the intestine, by normal-synthesis of vitamin D by the liver and kidneys, and by the effect of the normal-parathyroid gland. The main aim of the work was to give a profile of the causes of symptomatizing hypocalcemia in infants and children presenting to Assiut University Children Hospital. Patients and methods The study included 50 patients aged 2 months to 17 years (IRB#17100552). Besides full clinical assessment, all cases had the following investigations done: CBC, kidney and liver function test, serum calcium, alkaline phosphatase, vitamin D, and parathyroid hormone level measured. The chest radiography and wrist radiography were done in all cases. Intestinal biopsy was performed where indicated. Results Nutritional vitamin D-deficiency rickets was present in 62% of the cases, hepatic rickets was encountered in 6% of the cases, celiac disease was encountered in 8% of the cases, hypoparathyroidism was present in 4% of the cases, cow's milk allergy was present in 2% of the cases, and hypocalcemia secondary to antiepileptic drugs was present in 4% of the cases. Conclusion Vitamin D supplementation should be recommended during infancy and adolescence, where periods of rapid growth of bone occur. Good advice must be given to parents about foods rich in vitamin D and calcium.