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Not All Stridor Is Croup
1From the Wake Forest Baptist Medical Center, Winston-Salem, NC 27127.
Insights
Hypocalcemia can cause laryngospasm in infants, mimicking croup. Early recognition of low calcium is crucial for preventing severe outcomes in pediatric stridor cases.
Area of Science:
- Pediatrics
- Emergency Medicine
- Biochemistry
Background:
- Stridor in pediatric patients is frequently misdiagnosed as croup.
- Viral etiology is often presumed, overshadowing other critical diagnoses.
Observation:
- A 6-month-old infant presented with stridor and laryngospasm, initially treated for croup.
- The infant returned with seizures, revealing severe hypocalcemia (0.49 mmol/L).
- History revealed prolonged feeding with a homemade coconut water-based solution, leading to rickets and developmental delay.
Findings:
- Severe hypocalcemia was the underlying cause of laryngospasm in this infant.
- The infant's diet contributed to the development of rickets and hypocalcemia.
- Delayed diagnosis of hypocalcemia led to seizures and further complications.
Implications:
- Hypocalcemia must be considered in the differential diagnosis of pediatric stridor, particularly when viral symptoms are absent.
- Prompt identification and management of hypocalcemia are vital to prevent life-threatening events.
- Dietary practices in infants require careful evaluation, especially when homemade solutions are used.
Background:
Emergency providers often attribute stridor to croup in pediatric patients. However, even in children who are having other symptoms of a viral etiology, several other causes need to be considered.
Case:
A 6-month-old term male without significant past medical history presented to the emergency department with stridor with likely underlying laryngospasm. He was initially ascribed the diagnosis of croup and was discharged home after receiving steroids and racemic epinephrine. However, he returned hours later after a seizure event at home. A thorough evaluation revealed an ionized calcium of 0.49 mmol/L, and further history revealed the patient was being fed a coconut water-based homemade solution for several months. He was subsequently found to have rickets and delay in milestone achievement. Awareness of hypocalcemia as a possible cause of laryngospasm is important because of the potential life-threatening effects of critically low calcium. Hypocalcemia should be included in the differential diagnosis of any child who presents with stridor, especially if lacking other symptoms of a viral illness.
