Hypocalcemia is a recognized etiological factor of neonatal seizures. Common concept of calcium homeostasis is regulated by parathyroid hormone (PTH) and vitamin D. Vitamin D deficiency is well known to cause impaired intestinal Ca++ absorption, triggering secondary hyperparathyroidism. Herein, we report three Hispanic neonates who presented with hypocalcemic seizures (see Table). All of them were fed by breast milk supplemented by formula. Initial lab values revealed low serum calcium, elevated serum phosphorous and inappropriately low parathyroid hormone level. Unexpectedly, all the neonates and the mothers also had low 25 OH vitamin D levels as well. However, contrary to the classical hormonal profile, they had functional hypoparathyroidism instead of secondary hyperparathyroidism. The treatment of hypocalcemia secondary to functional or true hypoparathyroidism differs from that of vitamin D deficiency. And, hence, making a diagnosis based solely on serum calcium and phosphorous, frequently the lone labs available initially, can be problematic. Our observations underscore that not all neonates with hypocalcemia and hyperphosphatemia have hypoparathyroidism alone, and that concomitant vitamin D deficiency should be considered.
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