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Hypocalcemia and stridor: an unusual presentation of vitamin D-deficient rickets
1Department of Pediatrics, University of Rochester Medical Center, Strong Memorial Hospital, New York 14642-8655, USA.
Insights
Hypocalcemia causing laryngospasm is a critical diagnosis in infants with stridor. Prompt calcium treatment can rapidly resolve breathing difficulties in these cases.
Area of Science:
- Pediatrics
- Emergency Medicine
- Endocrinology
Background:
- Stridor in infants has a broad differential diagnosis.
- Hypocalcemia can lead to laryngospasm, presenting as stridor.
- Rickets is a potential underlying cause of hypocalcemia.
Observation:
- A breastfed infant presented with severe stridor during winter.
- The infant was diagnosed with hypocalcemia secondary to undiagnosed rickets.
- Symptoms significantly improved with intravenous calcium chloride administration.
Findings:
- The case highlights hypocalcemia as a treatable cause of pediatric stridor.
- Intravenous calcium chloride effectively resolved the infant's laryngospasm.
- Undiagnosed rickets was identified as the cause of hypocalcemia.
Implications:
- Emergency physicians should consider measuring ionized calcium in pediatric stridor cases.
- This is particularly important when initial treatments for common stridor causes fail.
- Early diagnosis and treatment of hypocalcemia can prevent severe respiratory distress.
Abstract:
The differential diagnosis of stridor in the pediatric population is broad and should include hypocalcemia with resultant laryngospasm. We present the case of a breast-fed infant who presented to the pediatric emergency department with profound stridor during the winter months because of hypocalcemia of undiagnosed rickets. The patient responded to intravenous calcium chloride with rapid resolution of symptoms. Emergency physicians should consider obtaining ionized calcium levels in pediatric patients with stridor, especially when standard therapies for more common causes of stridor are ineffective.