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A 6-month-old Inuit, formula-fed infant was taken to the emergency room by ambulance following a generalized tonic–clonic seizure. On examination, the infant was fussy and hypotonic. Biochemistry was consistent with severe vitamin D deficiency (undetectable 25-hydroxyvitamin D3 and urinary calcium to creatinine ratio, low serum ionized calcium, normal serum phosphate and elevated parathyroid hormone [PTH] and alkaline phosphatase). A hand radiograph showed no signs of rickets. Risk factors for vitamin D deficiency were determined to be severe maternal vitamin D deficiency and absence of infant postnatal vitamin D supplementation. Given the history of a seizure, the infant was treated with intravenous calcium along with oral vitamin D3 4000 IU/day and elemental calcium 50 mg/ kg/day in four divided doses. Once the ionized calcium was >1.0 mmol/L (after 72 hours), the intravenous calcium was discontinued. The patient remained on vitamin D3 4000 IU/day and supplemental calcium until the biochemistry normalized (total duration of high-dose therapy was 5 months). The infant was then transitioned to vitamin D3 800 IU/day as maintenance therapy, calcium supplementation was discontinued and adequate calcium intake was encouraged through dairy products to meet the recommended intake for age (260 mg elemental calcium daily).

Severe vitamin D deficiency: A persistent yet preventable problem among Canadian youth