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Hypocalcemic tetany in a toddler with undiagnosed rickets
R Y Duplechin1, M Nadkarni, R P Schwartz
1Department of Emergency, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA.
Insights
Exclusive breastfeeding can lead to vitamin D deficiency rickets and tetany in infants. This condition, characterized by low calcium and vitamin D levels, requires consideration in diagnosing acute hypocalcemia.
Area of Science:
- Pediatrics
- Nutritional Science
- Biochemistry
Background:
- Exclusive breastfeeding, while beneficial, can pose risks if maternal or infant vitamin D levels are insufficient.
- Nutritional deficiencies in infants require prompt recognition and intervention to prevent serious health complications.
Observation:
- A 17-month-old infant presented with acute symptoms of tetany, including involuntary "drawing up" of extremities.
- Clinical presentation suggested a potential underlying metabolic or nutritional disorder.
Findings:
- Diagnosis confirmed as vitamin D deficiency rickets with tetany.
- Laboratory results revealed low serum calcium, phosphorus, and 25-hydroxyvitamin D levels.
- Radiographic bone imaging supported the diagnosis of rickets.
Implications:
- Highlights the critical role of vitamin D screening and supplementation in exclusively breastfed infants.
- Underscores the importance of considering nutritional rickets in the differential diagnosis of acute hypocalcemia in pediatric patients.
- Emphasizes the need for public health awareness regarding infant nutrition and vitamin D sufficiency.
Abstract:
A 17-month-old black girl presented to the pediatric emergency department with sudden onset of her hands and feet "drawing up." A diagnosis of vitamin D deficiency rickets with tetany was made on a history of exclusive breast-feeding, low serum calcium, phosphorus, and 25-hydroxyvitamin D levels, and bone radiographs. Nutritional rickets should be considered in the differential diagnosis of acute hypocalcemia.