Hypomagnesemia presenting as hypertensive urgency and multiple focal seizures in an infant

Abstract

A fourty eight day old baby boy presented with a history of unprovoked, left sided focal seizures commencing at the age of 21 days of life and had recurrent hospital admissions previously. He was referred to our tertiary care centre for further evaluation. Clinical assessment on the day of presentation in the Emergency Room revealed a GCS of 13/15, without any focal neurological deficits and an anterior fontanelle that was level, but pulsatile. He was also noted to have severe hypertension. Laboratory parameters revealed hypocalcemia, hypomagnesemia and significantly low 25- OH- vitamin D levels with normal complete blood counts, liver and renal functions. Further endocrinology evaluation revealed a normal PTH level with increased fractional excretion of magnesium in urine. Seizure control was achieved with intravenous calcium and magnesium administration along with antiepileptic drugs. Hypertensive urgency needed appropriate management with nifedipine and labetalol initially and blood pressures normalized only after correction of serum magnesium levels. At discharge, all antihypertensive drugs could be tapered and discontinued. This interesting case highlights the issue of hypomagnesemia manifesting as hypertension, even up to levels of a hypertensive urgency in infants and children.