Rachitic hypocalcemic cardiomyopathy in an infant

Elidrissy, Abdelwahab T. H.; Al-Harbi, Khalid M.; Mufid, M; AlMezeni, Ibrahim

doi:10.1016/j.jsha.2016.05.001

Cited by 4 publications

(2 citation statements)

References 18 publications

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“…All improved with vitamin D and calcium supplementation with normalization of LVEF over the next 3 months. Elidrissy et al 24 conducted a review of 61 infants with hypocalcemic cardiomyopathy (mean age 5 months, range 1 month–15 months). All cases presented with heart failure and had hypocalcemia, high alkaline phosphatase, low vitamin D, and high PTH; and echocardiology was suggestive of cardiomyopathy.…”

Section: Discussionmentioning

confidence: 99%

Clinical Profile, Intensive Care Needs and Outcome of Children with Dilated Cardiomyopathy Associated with Vitamin D Deficiency: A 5-year PICU Experience

Bansal¹,

Angurana²,

Nallasamy³

et al. 2023

Indian Journal of Critical Care Medicine

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A bstract Aim To describe the clinical profile, treatment details, intensive care needs, and long-term outcome of children with dilated cardiomyopathy (DCM) associated with Vitamin D deficiency (VDD). Materials and methods Case records of 14 children with DCM associated with VDD [25(OH)D3 levels <20 ng/mL] admitted to the pediatric intensive care unit (PICU) of a tertiary care teaching hospital between January 2017 and December 2021 were retrospectively analyzed for clinical features, echocardiographic findings, treatment details, intensive care needs, and outcomes. Results The median (IQR) age was 6 (2–9) months and 71% ( n =10) were males. The common modes of presentation included respiratory distress or failure (78.6%), congestive cardiac failure (71.4%), cardiogenic shock (37.5%), and seizures and encephalopathy (14.3% each). The median (IQR) serum calcium was 8.7 (7–9.5) mg%, ionized calcium 0.7 (0.7–1.1) mmol/L, alkaline phosphatase 343 (316–415) IU/L, phosphate 3.5 (2.6–4.5) mg%, PTH 115 (66–228) pg/mL, and 25(OH)D3 5 (3–7) ng/mL. The median (IQR) left ventricular ejection fraction (LVEF) at admission was 22 (17–25)%. The treatment included intravenous calcium infusion (35.7%), vitamin D supplementation in all (57.1% parenteral and 42.9% oral), mechanical ventilation (35.7%), and vasoactive drugs (57.1%). There was no mortality. The median (IQR) duration of PICU and hospital stay was 76 (31–98) hours and 6 (4.7–10) days, respectively. Out of 14 children, 10 (71.4%) were followed-up till median (IQR) of 10 (7–58) months. All were asymptomatic and had normal LEVF (except one had residual moderate mitral regurgitation). Conclusion Vitamin D deficiency is a potentially treatable and reversible cause of DCM in children. How to cite this article Kumar S, Randhawa MS, Angurana SK, Nallasamy K, Bansal A, Kumar MR, et al . Clinical Profile, Intensive Care Needs and Outcome of Children with Dilated Cardiomyopathy Associated with Vitamin D Deficiency: A 5-year PICU Experience. Indian J Crit Care Med 2023;27(7):510–514.

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Section: Discussionmentioning

confidence: 99%

Clinical Profile, Intensive Care Needs and Outcome of Children with Dilated Cardiomyopathy Associated with Vitamin D Deficiency: A 5-year PICU Experience

Bansal¹,

Angurana²,

Nallasamy³

et al. 2023

Indian Journal of Critical Care Medicine

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“…As we see many cases of nutritional rickets, in which hypocalcemic convulsions is the commonest presentation in the fi rst year of life [2] and as it might be associated with other rare complications as cardiomyopathy [3] and myelofi brosis [4] and as well as iron defi ciency anemia [5] and as stridor is a serious complication jeopardizing respiration and as hypocalcemia due to vitamin D defi ciency is not uncommon, it is reviewed in this communication.…”

Section: Introductionmentioning

confidence: 99%

Hypocalcemic Rachitic Stridor: A Neglected Warning Sign in Infants

Ath¹

2017

Glob J Rare Dis

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Although stridor is a common respiratory symptom associated with upper respiratory diseases, yet its relation with hypocalcemia is not widely appreciated. The mechanism of hypocalcemia in causing stridor might be a collapsing of larynx most likely caused by decalcifi cation due to hypocalcemia. Vitamin D defi ciency causes a reduction in serum calcium, which stimulates the production of extra PTH to mobilize and maintain calcium from bone and cartilage for more vital cells of the body, brain, heart and blood. Stridor might appear with upper respiratory tract infection, accordingly the role of hypocalcemia as a cause of stridor might not be recognized. Infants are born with poor vitamin D in places with high prevalence of vitamin D defi ciency due to environmental, social, customs and housing factors. Due to maternal vitamin D defi ciency, breast milk is low in vitamin D which leads to poor absorption of calcium. Stridor caused by hypocalcemia should be considered as a warning sign to prevent more serious complications as cardiomyopathy, myelofi brosis, and convulsions. In communities with high prevalence of vitamin D defi ciency checking for hypocalcemia should be part of the work up, when stridor is the presenting symptom in infants. The mechanism by which hypocalcemia causes stridor might be laryngiomalacia.

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The importance of vitamin D in maternal and child health: a global perspective

2017

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Vitamin D and calcium are important nutrients for skeletal growth and bone health. Children and pregnant women are particularly vulnerable to 25-hydroxy vitamin D deficiency (VDD). VDD, with or without dietary calcium deficiency, can lead to nutritional rickets (NR), osteomalacia, and disturbances in calcium homeostasis. Multiple studies have linked VDD to adverse health outcomes in both children and pregnant women that extend beyond bone health. VDD remains an important global public health concern, and an important differentiation must be made between the impact of VDD on children and adults. Reports of increased incidence of NR continue to emerge. NR is an entirely preventable condition, which could be eradicated in infants and children worldwide with adequate vitamin D and calcium supplementation. The desire and necessity to put in place systems for preventing this potentially devastating pediatric disease should not elicit dispute. VDD and NR are global public health issues that require a collaborative, multi-level approach for the implementation of feasible preventative strategies. This review highlights the history, risk factors, and controversies related to VDD during pregnancy and childhood with a particular focus on global NR prevention.

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Rachitic hypocalcemic cardiomyopathy in an infant

Cited by 4 publications

References 18 publications

Clinical Profile, Intensive Care Needs and Outcome of Children with Dilated Cardiomyopathy Associated with Vitamin D Deficiency: A 5-year PICU Experience

Clinical Profile, Intensive Care Needs and Outcome of Children with Dilated Cardiomyopathy Associated with Vitamin D Deficiency: A 5-year PICU Experience

Hypocalcemic Rachitic Stridor: A Neglected Warning Sign in Infants

The importance of vitamin D in maternal and child health: a global perspective

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