Abstract
Objective: To determine the prevalence of vitamin D deficiency (25-hydroxycholecalciferol) in infants with hypocalcemic seizures and the relation of severity of vitamin D (25-hydroxy Cholecalciferol) deficiency with the occurrence of hypocalcemic seizures. Design: Cross sectional analytical study. Setting: pediatric emergency department of a tertiary care hospital. Methods: 60 consecutive term neonates and infants (upto 1 year) presenting with seizures with documented hypocalcemia (total serum calcium was <8 mg/dl, with normal serum albumin levels (≥4 mg/dl) were included as cases and 60 healthy term neonates and infants attending immunization clinic were taken as controls. A structured questionnaire was asked and blood samples taken for serum calcium, phosphorus, alkaline phosphatase, 25 hydroxycholecalciferol, albumin levels. Radiological assessment of rickets was also done in clinically suspected cases. Results: Majority of the cases had inadequate exposure to sunlight (73.3%) as compared to controls (41.7%). Vitamin D deficiency is seen in 88.3% cases and 68.3% controls (p=0.01). 31.7% of the cases were severely deficient in vitamin D. Thus vitamin D deficiency appears to be a major risk factor for hypocalcemic seizures. No significant relation between 25(OH)D and calcium in both cases and controls using spearman rank correlation. There was a significant inverse relation between 25(OH)D and S.ALP among controls and cases. Conclusion: High prevalence of vit D deficiency was noted in infants with hypocalcemic seizures however a high prevalence of vitamin D deficiency was also seen in healthy infants. Serum alkaline phosphatase can be taken as surrogate marker for vit D deficiency. Sunlight exposure < 30 minutes/week was likely to develop vitamin D Deficiency.
Highlights
Seizures are common in pediatric age group occurring in 4-7% of infants and children [1]
High prevalence of vit D deficiency was noted in infants with hypocalcemic seizures a high prevalence of vitamin D deficiency was seen in healthy infants
Serum alkaline phosphatase can be taken as surrogate marker for vit D deficiency
Summary
Seizures are common in pediatric age group occurring in 4-7% of infants and children [1]. Amongst the various etiologies hypocalcaemia is a major biochemical cause of seizures in infancy in the developing countries [2,3]. It constitutes 25.6% of afebrile seizures in children [4]. Causes of hypocalcemic seizures include prematurity, birth asphyxia, exogenous phosphate load, magnesium deficiency, hypoparathyroidism, malabsorption syndromes, pancreatitis, hypoalbuminemia (pseudohypocalcemia) and vitamin D deficiency [5]. Hypocalcemia due to vitamin D deficiency constitutes an important cause of infantile seizures in developing countries. A state of deficiency occurs months before rickets is obvious on physical examination and most frequently it presents as seizures
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