Vitamin D deficiency in children presenting to the emergency department: a growing concern. Vitamin D deficiency in Birmingham's children: presentation to the emergency department

Kehler, Lisa; Verma, Sapna; Krone, Ruth; Roper, E. A.

doi:10.1136/emermed-2012-201473

Cited by 10 publications

(3 citation statements)

References 11 publications

(13 reference statements)

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“…A possible link between acute neonatal seizures, hypocalcemia and subsequent severe intellectual disability has been assessed in 149 adults with 22q11.2 deletion syndrome. 65 A history of neonatal seizures and neonatal hypocalcemia were significant predictors of a more severe level of intellectual disability, suggesting that neonatal seizures may increase the risk for more severe intellectual deficits in 22q11.2 deletion syndrome, likely mediated by neonatal hypocalcemia.…”

Section: Hypocalcemiamentioning

confidence: 99%

Acute Symptomatic Seizures Caused by Electrolyte Disturbances

2016

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In this narrative review we focus on acute symptomatic seizures occurring in subjects with electrolyte disturbances. Quite surprisingly, despite its clinical relevance, this issue has received very little attention in the scientific literature. Electrolyte abnormalities are commonly encountered in clinical daily practice, and their diagnosis relies on routine laboratory findings. Acute and severe electrolyte imbalances can manifest with seizures, which may be the sole presenting symptom. Seizures are more frequently observed in patients with sodium disorders (especially hyponatremia), hypocalcemia, and hypomagnesemia. They do not entail a diagnosis of epilepsy, but are classified as acute symptomatic seizures. EEG has little specificity in differentiating between various electrolyte disturbances. The prominent EEG feature is slowing of the normal background activity, although other EEG findings, including various epileptiform abnormalities may occur. An accurate and prompt diagnosis should be established for a successful management of seizures, as rapid identification and correction of the underlying electrolyte disturbance (rather than an antiepileptic treatment) are of crucial importance in the control of seizures and prevention of permanent brain damage.

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Section: Hypocalcemiamentioning

confidence: 99%

Acute Symptomatic Seizures Caused by Electrolyte Disturbances

2016

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“…Moreover, IBS patients had significantly lower mean 25OHD. In a pediatric ED setting, Kehler et al [36] identified 89 children with VDD, the majority (83%) with severe VDD. The most common clinical manifestation for ED admission was abdominal pain and the most common ethnic origins were black African and Pakistani.…”

Section: Discussionmentioning

confidence: 99%

Vitamin D Deficiency and Unclear Abdominal Pain in Patients from Low- and Middle-Income Countries

Doulberis

Papaefthymiou

Kountouras

et al. 2019

IJERPH

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Background: Abdominal pain is one of the commonest symptoms in emergency departments (EDs). Diagnosis demands full attention and critical thinking, since many diseases manifest atypically and the consequences of overlooking the symptoms may be disastrous. Despite intensive diagnostic procedures, some cases remain elusive and unclear abdominal pain (UAP) is not infrequent. Emerging evidence supports the hypothesis that functional pain might be attributed to vitamin D deficiency (VDD). People with darker or covered skin are predisposed to developing VDD. Patients in Switzerland stemming from low- and middle-income countries (LMIC) are such a population. Aim: To identify cases with UAP in LMIC patients and to compare vitamin D status with a control group. Methods: A retrospective single-center case-control study was carried out from 1 January 2013 to 31 August 2016 in all adult patients (more than 16 years old) stemming from LMIC and presenting at the university ED of Bern with abdominal pain. Vitamin D status was retrieved from these cases when available. The control group consisted of patients without abdominal pain or metabolic diseases and was matched (1:1) to the cases for age, gender, body mass index, geographic distribution, and season of vitamin D estimation. Results: A total of 10,308 cases from LMIC were reported to the ED. In total, 223 cases were identified with UAP. The status of vitamin D was available for 27 patients; 27 matched individuals were subsequently retrieved for the control group. Women made up 56.7% of the UAP group and 43.3% of the control group. The most common origin of the LMIC subjects was southern Europe (20.4%), followed by southern Asia (16.7%) and Eastern Europe (13%). Fourteen UAP patients exhibited severe VDD (<25 nmol/L) versus one in the control group (p = 0.001). The difference remained significant if the patients were identified as having VDD (<50 nmol/L) or not (p = 0.024). Comparison of the means indicated that the UAP group had lower vitamin D levels than the control group (41.3 vs. 53.7 nmol/L, respectively), but this difference was marginal (p = 0.060) and not statistically significant. After adjustment for potential confounders, including gender, mean vitamin D levels remained non-significantly different between groups. In the sub-group analysis, vitamin D levels were lower in women than in men (p = 0.037), compared to the respective controls. Conclusion: This study showed for the first time that patients from LMIC who presented to ED with UAP displayed VDD. Validation from larger studies is warranted to evaluate the linkage of VDD with UAP.

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“…In a retrospective survey of children reported to be vitamin D insufficient (<50 nmol/l; <20 ng/ ml) in the United Kingdom, abdominal pain was the most common clinical feature (19%), with seizures and limb pain affecting around 16% of the children (Kehler et al, 2012). In Scotland, 160 cases of symptomatic vitamin D deficiency affecting infants and children aged 2 weeks to 14 years were identified between 2002 and 2008 (Ahmed et al, 2011).…”

Section: Childmentioning

confidence: 99%

Vitamin D and maternal and child health: Overview and implications for dietary requirements

Uriu‐Adams

Običan

Keen

2013

Birth Defects Research Pt C

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The essentiality of vitamin D for normal growth and development has been recognized for over 80 years, and vitamin D fortification programs have been in place in the United States for more than 70 years. Despite the above, vitamin D deficiency continues to be a common finding in certain population groups. Vitamin D deficiency has been suggested as a potential risk factor for the development of preeclampsia, and vitamin D deficiency during infancy and early childhood is associated with an increased risk for numerous skeletal disorders, as well as immunological and vascular abnormalities. Vitamin D deficiency can occur through multiple mechanisms including the consumption of diets low in this vitamin and inadequate exposure to environmental ultraviolet B rays. The potential value of vitamin D supplementation in high-risk pregnancies and during infancy and early childhood is discussed. Currently, there is vigorous debate concerning what constitutes appropriate vitamin D intakes during early development as exemplified by differing recommendations from the Institute of Medicine Dietary Reference Intake report and recent recommendations by the Endocrine Society. As is discussed, a major issue that needs to be resolved is what key biological endpoint should be used when making vitamin D recommendations for the pregnant woman and her offspring.

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Vitamin D deficiency in children presenting to the emergency department: a growing concern. Vitamin D deficiency in Birmingham's children: presentation to the emergency department

Abstract: Vitamin D deficiency should be considered in children with pigmented skin presenting with a range of symptoms. The detected vitamin D deficiency probably represents only a very small proportion of the vitamin D deficiency in children in Birmingham.

Cited by 10 publications

References 11 publications

Acute Symptomatic Seizures Caused by Electrolyte Disturbances

Acute Symptomatic Seizures Caused by Electrolyte Disturbances

Vitamin D Deficiency and Unclear Abdominal Pain in Patients from Low- and Middle-Income Countries

Vitamin D and maternal and child health: Overview and implications for dietary requirements

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