Hypocalcemic presented to the emergency department (ED) in the

Hypocalcemic Seizure in an Adolescent with
Obesity and Autism

Department of Pediatrics. Lincoln Medical and
Mental Health Center, Bronx NY.

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Weill-Cornell Medical College, New York, NY

 

Case  

 

 A 12-year-old Hispanic girl with
severe autism spectrum disorder (ASD), intellectual disability, and obesity
presented to the emergency department (ED) in the middle of winter with an
episode of unprovoked, tonic-clonic seizure that lasted 8 minutes.  Upon arrival to the ED she was afebrile 97.6°
F , pulse 110/min, respiratory rate 20/min, blood pressure 103/56 mmHg, O2 Sat
97% on room air, weight was 63.6 kg (95th %), height was 155 cm (61st
%) and Body Mass Index (BMI) was 26.4 (96th %). During examination
she was alert and awake. There was no facial dysmorphism and no findings of
rickets. The neurological exam showed no focal deficits, tremors, or other involuntary
movements. Tanner stage of puberty was 4. She showed limited social interactions and her communication skills
were limited to use of short phrases and significant echolalia.

 

Past medical history was remarkable for being
the product of a twin pregnancy and premature delivery at 24 weeks of
gestation. Since the patient was 3 years old, her diet consisted exclusively of
french fries with ketchup and Doritos® (corn chips), water and Sunny-Delight® (an
orange flavored, sugar-containing beverage). For years, the mother had
unsuccessfully made numerous attempts to expand the child’s diet. Because of
this limited intake a nutritional drink (Pediasure®) was used as a supplement
for several years. It was discontinued two years prior to this episode because
of the child’s worsening obesity. Her exposure to sunlight was limited because of her difficult
behaviors coupled with long harsh winters.

 

The laboratory evaluation was remarkable for
severe hypocalcemia, very low levels of Vitamin D and secondary
hyperparathyroidism (Table 1). The rest of the blood work was within normal
limits. 

 

Table 1

 

On admission

Normal values

Calcium (mg/dL)

6.0

8.4-10.5

Ionized Calcium(mg/dL)

3.4

4.5-5.3

PTH (Pg/ml)

309.9

14-72

Vit D (ng/dl)

x

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