After nine days of treament, parathyroid hormone and 25-hydroxyvitamin D levels normalize (31.4 pg/mL and 50.7 ng/mL, respectively). 10% calcium gluconate (at admission, 1440 mg 24h, 1250 mg 48h, 960 mg expressed as elemental calcium per day) followed by oral calcium as carbonate (48h, 500 mg 72h, 1000 mg expressed as elemental calcium per day) associated with cholecalciferol treatment (5000 IU per day, started from 24h) quickly restored normocalcemia (24h, 6.8 mg/dL 48h, 7.6 mg/dL 72h, 8.6 mg/dL). Radiographs of wrist and knee confirmed vitamin D deficiency rickets. The child had immigrated to Italy from North Africa, and he was exclusivey breast-fed with no vitamin D supplementation. Laboratory results revealed severe hypocalcemia (4.3 mg/dL), hypophosphatemia (3.1 mg/dL), increased alkaline phosphatase (2031 U/L normal values 80-645 U/L), parathyroid hormone (189 pg/mL, normal values 10-65 pg/mL), and 1,25-dihydroxyvitamin D (181.8 pg/mL normal values 20- 80 pg/mL) levels, and reduced 25-hydroxyvitamin D levels (12.8 ng/mL "desiderable levels" > 20 ng/mL) (2). Clinical examination showed a large anterior fontanelle, frontal bossing with no dysmorphic features, craniotabes, and hypotonia. Recently, a 10-month-old boy with generalized seizure (duration approximately 3 minutes) with normal temperature was admitted to our hospital. 10% calcium gluconate associated, if necessary, with calcitriol until serum calcium levels normalize. The authors reported that simptomatic hypocalcemia with tetany or convulsions should be treated with i.v. (1) on the management and treatment of vitamin D deficiency. We read with great interest the review article in Pediatrics by Misra et al.
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