Endocrine Abstracts

Introduction: The prevalence of vitamin D deficiency has been increasing worldwide. This can be due to inadequate exposure to sunshine, dietary deficiency, dark skin, covering the whole body due to religious custom. Here, we present an interesting case of a newborn baby with severe hypocalcemia developing seizures and severe cardiac problems secondary to maternal vitamin D deficiency.

Case history: A newborn male baby was admitted to cardiac ITU with a history of severe biventricular dysfunction (LVEF 35–40%), symptomatic treatment started with ionotrophic support. Initial investigation revealed PTH 10.4 pg/ml (11.1–79.5), ionized calcium 2.6 mg/dl (4.5–5.3), corrected calcium 5.5 mg/dl (7.6–11.3), vitamin D 8.31 ng/ml (30–100) and magnesium 1.1 mg/dl (1.3–2.7). Baby been started on calcium infusion, calcium syrup and capsule calcitriol. Corrected calcium improved to 7.3 mgs/dl (7.7–10.4) and then 9.3 mgs/dl, 7 and 15 days following admission respectively. Echocardiogram revealed good biventricular function on discharged. We understand that the mother had severe vitamin D deficiency and hypocalcemia during pregnancy and on low dose calcium and vitamin D tablets. On discharge mother was given six lakh units of ergocalciferol intramuscularly and started on calcium tablets. On further review calcium remained normal, the dosage of both calcium and calcitriol were reduced and later stopped. Three months later calcium and PTH remained normal.

Conclusion: The prevalence of fetal hypocalcemia secondary to maternal vitamin D deficiency is not well documented. Screening for this condition early in pregnancy should be included as part of routine investigation. This policy might reduce fetal morbidity and mortality.