Formula fed twin infants with recurrent hypocalcemic seizures with vitamin D deficient rickets and hyperphosphatemia

Area of Science:

• Pediatrics
• Endocrinology
• Nutritional Science

Background:

• Vitamin D deficient rickets is common in breastfed infants.
• Excessive phosphate intake causes late-onset hypocalcemia in formula-fed infants.
• Twins present unique nutritional challenges, increasing risks for deficiencies.

Purpose of the Study:

• To report a case of formula-fed hypocalcemic twins with vitamin D deficient rickets and hyperphosphatemia.
• To describe the diagnosis and successful treatment of these infants.
• To emphasize the importance of adequate nutrient intake during twin pregnancies.

Main Methods:

• Case report of 45-day-old formula-fed twins presenting with recurrent seizures.
• Diagnosis based on clinical presentation, laboratory findings (hypocalcemia, hyperphosphatemia), and radiologic evidence of rickets.
• Treatment involved oral supplementation with calcium and alfacalcidol.

Main Results:

• The twins were diagnosed with both vitamin D deficient rickets and hyperphosphatemia.
• Radiologic findings confirmed mild rickets.
• Following 3-5 months of supplementation, medication was discontinued with normal growth and biochemical parameters during a 6-month follow-up.

Conclusions:

• Formula-fed twins are at risk for hypocalcemia due to potential vitamin D deficiency and other factors like low birth weight and prematurity.
• Adequate vitamin D and calcium supplementation is crucial for pregnant women carrying twins.
• Early diagnosis and appropriate management are key to resolving rickets and hypocalcemia in infants.