THURSDAY, Jan. 22 (HealthDay News) -- A 9-month-old baby who presented with seizures and a bulging fontanelle was diagnosed as having rickets due to vitamin D deficiency, iron deficiency anemia and severe protein-calorie malnutrition, according to a case report published in the Jan. 22 issue of the New England Journal of Medicine.
Michael F. Holick, M.D., Ph.D., of Boston University Medical Center, and colleagues describe the case of the hypocalcemic patient who arrived at the hospital approximately 40 minutes after he began to have seizures. The boy was born at 36 weeks' gestation and had been exclusively breast-fed until three weeks prior to hospitalization, when he had been weaned and given milk-based formula and rice cereal.
Although hypocalcemia has numerous causes, in the patient's case, rickets was considered likely, not least because of widened fontanelles and frontal cranial bossing were also present, the report indicates. Vitamin D deficiency was suspected because the baby was breast-fed and the mother, of African descent, was at risk for vitamin D deficiency, the authors note. They suggest the child's severe hypocalcemia was probably caused by the recent switch to milk-based formula and a vitamin supplement that probably contained vitamin D.
"The milk-based formula contains high levels of phosphate, which could result in a normal calcium-phosphate product, and, together with the addition of vitamin D, could result in the hungry bone syndrome, producing hypocalcemia," the authors write.
Holick has disclosed relationships with several pharmaceutical companies, as well as grant support from the National Dairy Council and the UV Foundation.
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