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Case Report
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| An uncommon cause of apparent life-threatening event | ||||||
| Muhammad Waseem1, Dee Soontharothai1, Heidi Pinkert1, Evelyn Erickson2, Michael Trotman1 | ||||||
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1Department of Emergency Medicine, Lincoln Medical & Mental Health Center, Bronx, NY, United States.
2Department of Pediatrics, Lincoln Medical & Mental Health Center, Bronx, NY, United States. | ||||||
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| How to cite this article: |
| Waseem M, Soontharothai D, Pinkert H, Erickson E, Trotman M. An uncommon cause of apparent life-threatening event. International Journal of Case Reports and Images 2012;3(11):17–20. |
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Abstract
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Introduction:
An apparent life threatening event (ALTE) in infancy is a common reason for presentation to the emergency department (ED). We report a case of a breast-fed infant who presented with an ALTE secondary to hypocalcemia from undiagnosed rickets.
Case Report: A 9-month-old girl was brought to the ED because she stopped breathing. The parents reported that she stopped breathing for more than 20 seconds and was gasping for air. During the event, she became unresponsive and her eyes rolled back. There was a history of cough and nasal congestion with subjective fever for two days. Further questioning revealed that over the last few months, she had had episodes of 'gasping', and 'strange noisy breathing sounds.' Her mother reported an 'odd cough' for several months. The baby had been exclusively breast-fed and was noted by her mother to be feeding well. No solid foods had been introduced to the patient. The past medical history was significant for developmental delay. The patient was born full-term via normal spontaneous vaginal delivery. The pregnancy, however, had been complicated by oligohydramnios. The parents reported no family history of vitamin D deficiency, rickets or seizure disorder. A chest radiograph showed flaring of the costochondral junctions consistent with rickets. Her vitamin D 25-OH level was 5 ng/mL (20–100) and D3 level was less than 5 ng/ml. Conclusion: Hypocalcemia is a difficult to diagnose in infants because there may present with a wide range of non-specific clinical symptoms, or they may be asymptomatic. It is important for the emergency physician to recognize the association of hypocalcemia with ALTE in infants. Rickets is a re-emerging health problem in infants and children. Physicians should therefore maintain a high index of suspicion for hypocalcemia especially in a breast-fed infant. We suggest including serum calcium level as part of the evaluation of ALTE. | |
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Key Words:
Rickets, Hypocalcemia, Seizures; ALTE
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Author Contributions:
Muhammad Waseem – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Dee Soontharothai – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Heidi Pinkert – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Evelyn Erickson – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Michael Trotman – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published |
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Guarantor of submission:
The corresponding author is the guarantor of submission. |
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Source of support:
None |
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Conflict of interest:
Authors declare no conflict of interest. |
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Copyright:
© Muhammad Waseem et al. 2012; This article is distributed the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.) |
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