Case 1: Neonate with seizures and hypocalcemia

Abstract

A 10-day-old boy born in September was admitted with new-onset focal seizures. In the previous six days, his parents had noted left-sided arm and leg twitching, right-sided head turning and lip smacking. These episodes lasted for approximately 30 s, and their frequency had increased to seven times per hour before admission. There was no history of fever, trauma, sick contacts or neonatal sepsis risk factors. The baby was breastfed and supplemented with formula. The pregnancy was unremarkable and the baby was born at term by an uncomplicated caesarian section because of a previous caesarian section. His birth weight was 4.1 kg (75th to 95th percentile). The mother was originally from Ecuador. The boy’s family history was otherwise noncontributory. On admission, focal seizures, as described, were witnessed. The baby’s weight was 4.1 kg. He was afebrile with normal vital signs. He had no dysmorphic features and his physical examination was otherwise unremarkable. Initial blood work showed normal renal function and electrolytes, with hypocalcemia (total calcium 1.80 mmol/L [normal 1.96 mmol/L to 2.66 mmol/L] and ionized calcium 0.82 mmol/L [normal 1.14 mmol/L to 1.29 mmol/L]) and hyperphosphatemia 3.30 mmol/L (normal 1.62 mmol/L to 3.10 mmol/L). His blood glucose level was within normal limits at 4.3 mmol/L. The diagnosis was revealed after further maternal history and blood tests.