Elsevier

The Journal of Pediatrics

Volume 211, August 2019, Pages 98-104.e4
The Journal of Pediatrics

Original Article
Population-Based Incidence of Potentially Life-Threatening Complications of Hypocalcemia and the Role of Vitamin D Deficiency

Portions of this study were presented as a poster at the North American Primary Care Research Group annual meeting, November 10, 2018, Chicago, Illinois.
https://doi.org/10.1016/j.jpeds.2019.02.018Get rights and content

Objectives

To determine the incidence of potentially life-threatening complications of hypocalcemia in infants and children in Olmsted County, Minnesota; and to determine if vitamin D deficiency contributed to these events and was, at the time of clinical presentation, considered as a possible cause.

Study design

In this population-based descriptive study, data were abstracted from the Rochester Epidemiology Project, a medical record linkage system covering 95% of patients in Olmsted County, Minnesota. Participants were children aged 0-5 years who resided in Olmsted County between January 1, 1996 and June 30, 2017, and who received diagnoses of seizures, cardiomyopathy, cardiac arrest, respiratory arrest, laryngospasm, and/or tetany. The incidence of hypocalcemia plus a potentially life-threatening complication was calculated.

Results

Among 15 419 patients aged 0-5 years in Olmsted County during the study period, 1305 had eligible complications: 460 had serum calcium checked within 14 days of presentation and 85 had hypocalcemia. Patients were excluded when causes other than hypocalcemia likely triggered the complication, leaving 16 children whose complication was attributed to hypocalcemia. Three of these 16 patients had a serum 25-hydroxyvitamin D measurement and 2 were deficient (≤6 ng/mL [15 nmol/L]). Among children aged 0-5 years, the incidence of hypocalcemia plus a potentially life-threatening complication was 6.1 per 100 000 person-years (95% CI, 3.5-10.0).

Conclusions

Vitamin D deficiency is an underinvestigated cause of complications of hypocalcemia in children. Serum calcium and 25-hydroxyvitamin D should be measured in children with these complications to identify possibly life-threatening vitamin D deficiency.

Section snippets

Methods

We conducted a population-based descriptive study in Olmsted County, Minnesota, using the database of the Rochester Epidemiology Project. The Rochester Epidemiology Project database is a population-based medical record linkage system that includes >50 years of health care use, diagnostic, and laboratory data from virtually all medical providers in Olmsted County, Minnesota, covering 98% of all health care services provided for Olmsted County residents.21, 22 The county is served by 2 large

Results

Between January 1, 1996, and June 30, 2017, 1305 of 15 419 patients aged 0-5 years in Olmsted County had eligible life-threatening complications. Specifically, 930 patients had seizures, 338 had cardiac arrest, 105 had respiratory arrest, 75 had laryngospasm, 66 had cardiomyopathy, and 2 had tetany. Among these patients, 460 (35%) had a serum calcium level measurement and 85 (18.5% of patients with a serum calcium level measured) had a serum calcium below the laboratory reference range for

Discussion

For the majority of children with life-threatening complications of hypocalcemia, it is unknown whether vitamin D deficiency contributed to their hypocalcemia, because serum 25(OH)D was never measured. Despite this, we confirmed 2 cases of hypocalcemic cardiac and respiratory arrest owing to severe vitamin D deficiency, which was associated with rickets. Their 25(OH)D values of ≤6 ng/mL placed them profoundly below the lower end of the recommended minimum of 20 ng/mL. Both were breastfed and

Data Statement

Data sharing statement available at www.jpeds.com.

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    Supported by the US National Institutes of Health's National Center for Advancing Translational Sciences (UL1 TR002377). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The authors declare no conflicts of interest.

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