Ann Pediatr Endocrinol Metab.  2015 Jun;20(2):102-105. 10.6065/apem.2015.20.2.102.

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

• Jo BW
• Shim YJ
• Choi JH
• Kim JS
• Lee HJ
• Kim HS

• KMID: 2368994
• DOI: http://doi.org/10.6065/apem.2015.20.2.102

Abstract

Vitamin D deficient rickets is generally known to occur in breast fed infants. And excessive phosphate ingestion is a main cause of late onset hypocalcemia in formula fed infants. Here we introduce 45-day-old formula fed hypocalcemic twins with recurrent seizure attacks. They were diagnosed as having both of vitamin D deficient rickets and hyperphosphatemia. Radiologic findings indicated mild rickets and the twins were treated with calcium and alfacalcidol. After 3-5 months of oral supplementation, medication was discontinued in both twins. They showed normal growth and calcium, phosphorus, and vitamin D levels during the 6-month follow-up period. Twins can be at risk for hypocalcemia because of their high risk of vitamin D deficiency, low birth weight, and premature birth. Therefore twin pregnant women need ingestion of sufficient vitamin D and calcium.

Keyword

Twins; Vitamin D deficiency; Hypocalcemia; Seizures; Rickets

MeSH Terms

Breast
Calcium
Eating
Female
Follow-Up Studies
Humans
Hyperphosphatemia*
Hypocalcemia
Infant*
Infant, Low Birth Weight
Infant, Newborn
Phosphorus
Pregnant Women
Premature Birth
Rickets*
Seizures*
Twins*
Vitamin D Deficiency
Vitamin D*
Calcium
Phosphorus
Vitamin D

Figure

• 

  Fig. 1 Radiologic findings of neonate with hypocalcemic seizure due to vitamin D deficient rickets. (A) In forearm x-ray, diffuse bilateral symmetrical linear periosteal reaction along the metadiaphyses of long bones is shown (white arrow). (B) After treatment, the radiologic finding is improved (white arrow).

• 

  Fig. 2 Skull x-ray of infant with hypocalcemic seizure due to vitamin D deficient rickets. Diffuse osteopenia and vague calvarium, temporal bone is shown (white arrows).

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  Fig. 3 The progress of serum calcium, phosphorus, 25-hydroxyvitamin D3 (25-D) and immunoreactive parathyroid hormone (iPTH) during treatment in twin infants with hypocalcemic seizure due to vitamin D deficiency and hyperphosphatemia. First twin (A) and second twin (B).

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