Hypocalcemia and nutritional rickets in children: common etiological factors

Abstract

Backgroud: Hypocalcemia can be defined as a state when serum calcium level is less than 7 mg/dl in preterm neonates and less than 8 mg/dl in term neonates and less than 8.5 mg/dl in older children. Nutritional rickets is commonly associated with rickets in children. Objective: To determine the common etiological factors of hypocalcemia and nutritional rickets in children. Study design: Cross sectional analytical study. Place and duration of study: This study was conducted in the department of Pediatrics, King Edward Medical University/Mayo hospital Lahore from March 1998 to January 2001. Patients and methods: 120 patients (2 months to 60 months) who presented with tetany, clinical and skeletal manifestations of rickets and seizures were included in the study. Biochemical profile (serum calcium, phosphate and alkaline phosphatase) and radiographs of wrist joint were done. Each child was accessed for age, sex, feeding pattern, exposure to sunlight, number of children in family, maternal age, educational sta tus of mothers, presenting features of the disease, total calcium, phosphate and alkaline phosphatase level in the serum and X-ray wrist. Results:: The study group comprised of 120 children (72 boys & 48 girls) ranging from 2 months to 3.5 years. 65% of the children had weight below 5th centile on National Center for Health Statistics charts. 32% of children got sunlight exposure for less than 30 minutes/week and 16% got it for 30-120 minutes/week. Out of total 120, 110 were below 2years among these 110, 9% were exclusive breast fed, 35% got diluted fresh milk, 1% got formula milk and 13% got both breast and bottle feeding. In 45% children weaning was not started. 47.5% couples had 2 or more children. 72% mothers were below 30 years of age, at the time of interview. 31% of the mothers were uneducated. 85% children had seizures at the time of presentation. Out of these 24.51% had upper respiratory tract infection and 51.96% had lower respiratory tract infection 79% had clinical signs of florid rickets. 67.5% of patients were had serum calcium between 6 & 7mg/dl, 69% were had serum phosphate level < 4 mg/dl and 76% had alkaline phosphatase level >1000IU/L. Conclusion: Hypocalcemia represents a major health problem in Pakistani children. Infants under 2 years of age are liable to have vitamin D deficiency rickets particularly if they are exclusively breastfed or received fresh milk with reduced exposure to sunlight. The higher the level of education of mothers, the less likely is the chance that their children become rachitic. Hypocalcemia can present with a wide variety of symptoms, the most important of which are seizures and recurrent chest infections. Rickets must be looked for as an underlying cause of these complaints.