scholarly journals Severe Hypocalcemia and Vitamin D Deficiency in Adolescence - A Case Series

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A220-A220
Author(s):  
Rachel Rothstein ◽  
Natalie Allen
Keyword(s):  
Vitamin D ◽  
Calcium Carbonate ◽  
Vitamin D Deficiency ◽  
Calcium Gluconate ◽  
Sun Exposure ◽  
Urgent Care ◽  
Restricted Diet ◽  
Oral Calcium ◽  
X Ray ◽  
History Of

Abstract Background: Hypocalcemia due to vitamin D (vit D) deficiency is uncommon among adolescents in the US. Only 3% to 6% of those ages 12- to 19-years-old have a vit D level <12 ng/ml.1 We present three cases of severe hypocalcemia secondary to vit D deficiency in non-obese adolescents with restricted diets and limited sun exposure. Clinical Cases: A 14-year-old Ethiopian male with history of absence seizures presented with bloody stool. Incidentally, labs revealed: Ca 5.6 (8.4–10.2) mg/dL, iCal 0.71 (1.2–1.38) mmol/L, PTH 295.1 (10.0–65.0) pg/mL, 25(OH)D <4 (20–100) ng/mL, Mg 1.9 (1.7–2.2) mg/dL, PO4 3.8 (2.5–4.5) mg/dL. He endorsed weight loss and knee pain, but denied paresthesias, tetany and seizures. He was a vegetarian and had minimal sun exposure. EKG and femur X-ray were unremarkable. He was started on IV calcium gluconate initially. Oral calcium carbonate and cholecalciferol were started on days three and four. He was discharged on day ten with iCal 0.84 on oral calcium carbonate and calcitriol. A 16-year-old male with history of autism, ADHD and bipolar disorder presented with a seizure. Labs revealed: Ca 5.7, iCal 0.62, PTH 372, 25(OH)D <4, Mg 1.9, PO4 3.5. Exam showed tetany, carpopedal spasms and positive Trousseau and Chvostek signs. EKG revealed prolonged QTc of 480 (<450) ms. He had a restricted diet and minimal sun exposure. His mother described his gait as “waddling” for the past two years. X-ray revealed bilateral femoral head fractures and evidence of rickets. He underwent bilateral surgical repair. He was started on IV calcium gluconate initially. Oral calcium carbonate and cholecalciferol were started on days two and four. He was discharged on day 14 with iCal 1.01 on oral calcium carbonate and cholecalciferol. A 16-year-old male with history of severe food allergies and restricted diet presented with a seizure. He visited urgent care three months prior for perioral tingling, muscle cramps and chest pain. He started a multivitamin for “low Ca” and “prolonged QTc.” The ED labs revealed: Ca 4.8, PTH 414.8, 25(OH)D 11, Mg 1.9, PO4 5.0, Alk Phos 539 (44–147) IU/L. Exam showed upper extremity twitching and QTc was 543 ms. He received 2 g calcium gluconate IV, then began oral calcium carbonate and cholecalciferol and continued supplementation following discharge on day six. Conclusions: Vit D deficiency among adolescents is re-emerging, likely due to decreasing sun exposure, unbalanced diets and increasing obesity.2 Adolescents with restricted diets due to allergy or behavioral disorders may be at higher risk of vit D deficiency. Increased screening of high-risk adolescents may lead to early identification of cases. References: 1) Palacios, C., et al. Is vitamin D deficiency a major global public health problem? J Steroid Biochem Mol Biol. 2013;144PA;138-145 2) Antonucci, R., et al. Vitamin D deficiency in childhood: old lessons and current challenges. J Pediatr Endocrinol Metab. 2018;31(3);247–260.

Vitamin D inadequacy among asthmatic Iraqi Children

2018 ◽  
Vol 9 (SPL1) ◽  
Author(s):  
Zainab A Razak Al-Sharifi ◽  
Haider Abd Al Jabbar
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Serum Alkaline Phosphatase ◽  
Serum Vitamin ◽  
Sun Exposure ◽  
Clinical History ◽  
Serum Vitamin D ◽  
Vitamin D Levels ◽  
History Of ◽  
Laboratory Investigations

Vitamin D assumes a part in the pathogenesis of asthma as it has an intense immunomodulatory impact following up on the cells of the innate immunity. It additionally decreases the danger of respiratory viral diseases which are critical initiators of asthma intensifications. Additionally,it potentiates the mitigating activity of corticosteroids which are viewed as the best controllers of asthma. To identify the recurrence of vitamin D inadequacy and lack among Iraqi asthmatic kids and to relate vitamin D levels to the seriousness of asthma. This case control study was directed on 50 asthmatic kids and 50 healthy controls. All were subjected to clinical history taking including history of sun introduction and asthma medication and full clinical examination. Laboratory investigations included estimation of serum calcium,serum alkaline phosphatase and serum 25-OH-D levels. There was a significant association between vitamin D deficiency and seriousness of asthma,yet there was no significant correlation between sun exposure and 25-OH-D level. Vitamin D deficiency is common in Iraqi children with asthma.Low levels of serum vitamin D are connected with high asthma seriousness,decreased asthma control.

scholarly journals Denosumab Induced Severe Prolonged Hypocalcemia in Metastatic Prostate Cancer

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A190-A190
Author(s):  
Hassan Mehmood ◽  
Farhad Hasan
Keyword(s):  
Prostate Cancer ◽  
Vitamin D ◽  
Calcium Carbonate ◽  
Serum Calcium ◽  
Calcium Gluconate ◽  
Metastatic Prostate Cancer ◽  
High Dose ◽  
Appendicular Skeleton ◽  
Qtc Interval ◽  
Oral Calcium

Abstract Background: Denosumab is a RANK-l inhibitor that, in addition to the treatment of osteoporosis, is used in patients with advanced cancer and metastatic bone disease to prevent skeletal-related events. Although denosumab is generally safe and effective, it can cause hypocalcemia which in some patients can be severe and life threatening. We present a case of severe prolonged hypocalcemia after a single dose of denosumab in a patient with metastatic prostate cancer. Case: A 78-year-old male with a past medical history of stage 4 prostate cancer on antiandrogen treatment with GnRH antagonist presented with severe hypocalcemia. Physical exam revealed a blood pressure 125/80 mm Hg, pulse 115 per min and weight 135 lb with negative Chvostek’s and Trousseau’s signs. The electrocardiogram showed supraventricular tachycardia with prolonged QTc interval of 503 ms (<430 ms). Labs showed serum calcium 4.9mg/dL (8.5–10.5), albumin 2.5g/dL (3.6–5.1), corrected calcium 5.7 mg/dL, ionized serum calcium 0.64mmol/L (1.05–1.3), creatinine 1.10mg/dL (0.7–1.2), eGFR >60, phosphorus 2.0mg/dL (2.5–4.5), magnesium 1.9 mg/dL (1.6–2.6), 25-OH vitamin D 29.7 ng/mL (30–100), 1,25 dihydroxy vitamin D 174 pg/mL (18–64), iPTH 244.0 pg/mL (11–68) and PSA 1860 ng/mL. Three weeks prior to presentation, the patient received 120 mg of subcutaneous denosumab. Pre-treatment serum calcium was 9.2 mg/dL (8.5–10.5), and Tc-99m bone scan showed multiple osteoblastic osseous metastatic lesions involving both axial and appendicular skeleton. The patient was diagnosed with denosumab-induced severe hypocalcemia and started on intravenous (IV) calcium gluconate infusion, oral phosphate 250 mg twice daily, and ergocalciferol 50,000 IU twice weekly. He required IV calcium gluconate up to 10 g per day in addition to oral calcium carbonate 2 g t.i.d. for 2 weeks to resolve hypocalcemia and normalize QTc interval. Patient was discharged to nursing home on calcium carbonate 2 g q.i.d. with IV calcium gluconate as needed to keep corrected calcium >8.0 mg/dL. After discharge he required up to 4 g of IV calcium and 8 g of oral calcium per day. Unfortunately, he presented again with severe hypocalcemia 5 weeks after discharge. In addition to current regimen of oral and IV calcium boluses, low dose calcitriol was started. We were only able to maintain his serum calcium>8.0 mg/dL by administering high daily dose of oral calcium carbonate 8 g /day and calcitriol 2 mcg daily. Due to poor prognosis, he was transitioned to hospice care and died 2 weeks later. Discussion: There are not many case reports on severe prolonged hypocalcemia secondary to denosumab in cancer patients but normal kidney function. Our patient remained on high dose of calcium even 101 days after denosumab administration. Reference: 1. Milat F et al. Prolonged hypocalcemia following denosumab therapy in metastatic hormone refractory prostate cancer. Bone. 2013 Aug 1;55(2):305–8.

Vitamin D Deficiency in Patients with Acute Myocardial Infarction: An Italian Single-Center Study

2015 ◽  
Vol 85 (1-2) ◽  
pp. 23-30 ◽  
Author(s):  
Aneta Aleksova ◽  
Rita Belfiore ◽  
Cosimo Carriere ◽  
Salam Kassem ◽  
Salvatore La Carrubba ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Primary Source ◽  
Sun Exposure ◽  
Female Gender ◽  
Developed Countries ◽  
Vitamin D Status ◽  
High Exposure

Abstract. Background: Hypovitaminosis D is a vitamin deficiency that has been increasing in developed countries; it was also suggested as an emerging risk factor for developing of atherosclerosis and acute myocardial infarction. The primary source of vitamin D is its cutaneous synthesis under exposure to sunlight. It has been suggested that 30 min of sun exposure twice weekly leads to sufficient vitamin D synthesis. The residents of Trieste (Italy) are well-known for their high exposure to sunlight in all seasons. We aimed to investigate the vitamin D status in subjects with acute myocardial infarction living in this area. Methods: Vitamin D status was identified in 478 subjects diagnosed with acute myocardial infarction. Results: The median serum 25-hydroxyvitamin D concentration was 14.5 [7.8 - 22.7] ng/mL. Vitamin D deficiency and insufficiency were present in 324 (68 %) and 107 (22 %) subjects, respectively. Vitamin D deficiency was less frequent among subjects enrolled in the period from July to the end of September (p < 0.001). In a multivariate analysis vitamin D deficiency was predicted by older age (p = 0.02), female gender (p = 0.002), higher body mass index (p = 0.05), autumn/winter sampling (p < 0.001), increased parathyroid hormone (p = 0.03) and alkaline phosphatase (p = 0.003). Conclusions: We observed very high prevalence of vitamin D deficiency among subjects with myocardial infarction in all seasons of enrollment. However, it was lower in the summer when sun exposure is higher. The exposure to sunlight may be a cost-saving therapeutic strategy for the management of vitamin D deficiency.

scholarly journals Knowledge and attitudes towards vitamin D food fortification

2019 ◽  
Vol 49 (3) ◽  
pp. 346-358 ◽  
Author(s):  
Beth Clark ◽  
Julie Doyle ◽  
Owen Bull ◽  
Sophie McClean ◽  
Tom Hill
Keyword(s):  
Public Health ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
South Asians ◽  
Middle Eastern ◽  
Sun Exposure ◽  
Food Fortification ◽  
Pilot Studies ◽  
Content Type ◽  
Far Eastern

Purpose Vitamin D deficiency is a well-recognised public health problem within the UK, with specific population groups more vulnerable to deficiency. Two pilot studies were used to explore awareness of vitamin D deficiency and attitudes towards food fortification. Design/methodology/approach A survey of 120 participants from five at-risk groups (South Asians, Blacks, Middle Eastern, Far Eastern and Caucasian older adults over 65 years) plus a group of British Caucasians who do not avoid sun exposure explored awareness of vitamin D, sun exposure knowledge and behaviour and attitudes towards food fortification. The latter group was included to provide a comparison group who were at a reduced risk of deficiency. χ2 was used to test associations between categorical variables and the study groups. The second study used three focus groups and two interviews, conducted on young South Asian females and examined knowledge and awareness of vitamin D and vitamin D-fortified foods. Findings A lack of knowledge and misconceptions were highlighted by both studies in relation to at-risk factors, including sunlight exposure (p = 0.037), dietary intakes (p = 0.0174) and darker skin pigmentation (p = 0.023), sources of vitamin D and the health benefits associated with optimal consumption. Attitudes to mandatory fortification of some foods varied significantly (p = 0.004) between the groups with acceptance rates for Blacks (68 per cent), those over 65 years (50 per cent), Middle Eastern (67 per cent) and Far Eastern (73 per cent), whereas the control (71 per cent) showed no acceptance, and South Asians gave a mixed response (48 per cent No). Focus group findings highlighted positive views towards fortification, although this was less for mandatory as opposed to voluntary fortification. Both pilot studies highlight the need for more research into this area, to create more effective public health policies. Originality/value The research presents novel insights into a topical area where there is limited research.

scholarly journals Seasonal Variation in Vitamin D in Association with Age, Inflammatory Cytokines, Anthropometric Parameters, and Lifestyle Factors in Older Adults

2017 ◽  
Vol 2017 ◽  
pp. 1-14 ◽  
Author(s):  
Leticia Elizondo-Montemayor ◽  
Elena C. Castillo ◽  
Carlos Rodríguez-López ◽  
José R. Villarreal-Calderón ◽  
Merit Gómez-Carmona ◽  
...  
Keyword(s):  
Older Adults ◽  
Vitamin D ◽  
Seasonal Variation ◽  
Vitamin D Deficiency ◽  
High Probability ◽  
Sun Exposure ◽  
Serum Levels ◽  
Lifestyle Factors ◽  
Anthropometric Parameters ◽  
Healthy Older Adults

Vitamin D deficiency is present even in sunny regions. Ageing decreases pre-vitamin D production in the skin and is associated with altered cytokine profile. We performed a multivariate analysis considering lifestyle factors, anthropometric, and inflammatory markers according to seasonal variation in Mexican healthy older adults. The same cohort was followed during 12 months. Vitamin D deficiency/insufficiency was found in 91.3% of the subjects despite living in appropriate latitude (25°40′0″N). 25(OH)D levels remained below <30 ng/mL through all seasons. Vitamin D deficiency did not correlate to sun exposure or dietary intake. Gender was the strongest associated factor, explaining a variance of 20%. Waist circumference (WC) greater than 88 cm was a risk factor for vitamin D deficiency. Age (>74 years) combined with WC (>88 cm) and BMI (>32.7) showed a high probability (90%) of vitamin D deficiency. Remarkably, an increase in one centimeter in WC decreased 25(OH)D by 0.176 ng/mL, while an increase in one point BMI decreased 25(OH)D by 0.534 ng/mL. A cutoff point of 74 years of age determined probability of vitamin D hipovitaminosis. Vitamin D deficiency was correlated with TNF-αserum levels, possibly increasing the susceptibility of older adults to a proinflammatory state and its related diseases.

scholarly journals KNOWLEDGE AND PRACTICES REGARDING VITAMIN D DEFICIENCY AMONG WOMEN ATTENDING IMAM HUSSEIN MEDICAL CITY IN KARBALA 2018

2019 ◽  
pp. 39-43
Author(s):  
SARAH JAFAR AL-GHRAIBAWI ◽  
SAAD IBRAHIM AL-GHABBAN ◽  
RIYADH DHEYHOOD AL-ZUBAIDY
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Public Awareness ◽  
Sun Exposure ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Significant Difference ◽  
Medical City ◽  
The Mean ◽  
Socio Demographic Factors

Objective: Vitamin D deficiency is a global health problem. It is significantly associated with skeletal and non-skeletal problems. Prevention can be maintained mainly by effective sun exposure or supplementation and to lesser extent by dietary intake. To determine the magnitude of knowledge and practice of women towards vitamin D deficiency. Methods: A cross-sectional study, purposive sample of 442 women were approached who attended consultants’ clinics of Imam Hussein Medical City in Karbala. Data collection done between March 2 and June 30, 2018 through direct interviews using a special questionnaire prepared for the purpose of the study. Results: Less than half (45.2%) of the women had heard about vitamin D; their source of information was from relatives and friends then from health care provider. The mean score for the participants’ knowledge about VDD was 4.25 out of 9.0 (47%). It has a significant association with higher educational levels and urban residence. There is no significant difference regarding age, marital status or occupation. The mean score for the participants’ practice about vitamin D deficiency was 2.53 out of 5 (50.71%). There is no influence of practice score by socio-demographic factors. Conclusion: Overall knowledge towards vitamin D deficiency was suboptimal. Improving practices towards VD is directly related to increase knowledge about it that indicates the need to increase public awareness about the problem, encourage appropriate way of sun exposure, consumption of vitamin D rich food and taking supplementation when sun exposure is difficult.

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