Hypocalcemic Seizure Due to Vitamin D Deficiency

Abstract

A bstract Aim To emphasize the importance of vitamin D supplementation. Background The incidence of vitamin D deficiency has been increasing worldwide, probably due to decreased exposure to sunlight and unbalanced diet. Severe hypocalcemia following vitamin D deficiency is rather uncommon, and this leading to seizures in adults is a rare scenario. Case description This is the case of a 70-year-old female, a known case of coronary artery disease, who presented with one episode of seizure. Computed tomography of her brain revealed diffuse age-related atrophic changes, and electroencephalogram showed diffuse cerebral dysfunction. She was found to have severe hypocalcemia with secondary hyperparathyroidism due to vitamin D deficiency. Vitamin D bolus was given along with calcium correction, following which she improved. Conclusion There are a few reports of hypocalcemic seizures among children; however, the incidence is rare among adults. Calcium and vitamin D supplementation forms the mainstay of treatment. Clinical significance Hypocalcemic seizure is uncommon, especially among adults. Vitamin D deficiency resulting in hypocalcemic seizure, to the best of our knowledge, is an unreported scenario. This case highlights the importance of vitamin D supplementation in those with reduced sunlight exposure. How to cite this article Manappallil RG, Krishnan R, Veetil PP, Nambiar H, Karadan U, Anil R, et al. Hypocalcemic Seizure Due to Vitamin D Deficiency. Indian J Crit Care Med 2020;24(9):882–884.

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“…Oral replacement is suitable, except for severely low magnesium (<1.0 mg/100 ml), suspected malabsorption, or persistent symptoms, where IV replacement is preferred. Thus, intravenous magnesium sulfate is the preferred option for the treatment of hypomagnesemia in these patients 25 . It is commonly administered at 25−50 mg/kg/dose (up to 2 g/dose) every 4−6 hour (every 8 hr in neonates) as needed for repletion of serum magnesium 40 , 41 .…”

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“…Serum 25-hydroxyvitamin D levels greater than 20 ng/mL are generally considered adequate for bone and overall health in healthy individuals [ 6 ]. Vitamin D deficiency has been shown to induce hypocalcemic seizures with calcium levels as low as 6.4 mg/dL [ 7 ]. Our patient presented with a calcium of 3.9 mg/dL, which is below the value that would be explained by vitamin D deficiency alone.…”

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