Population-Based Incidence of Potentially Life-Threatening Complications of Hypocalcemia and the Role of Vitamin D Deficiency

J Pediatr. 2019 Aug:211:98-104.e4. doi: 10.1016/j.jpeds.2019.02.018. Epub 2019 Apr 4.


Objectives: To determine the incidence of potentially life-threatening complications of hypocalcemia in infants and children in Olmsted County, Minnesota; and to determine if vitamin D deficiency contributed to these events and was, at the time of clinical presentation, considered as a possible cause.

Study design: In this population-based descriptive study, data were abstracted from the Rochester Epidemiology Project, a medical record linkage system covering 95% of patients in Olmsted County, Minnesota. Participants were children aged 0-5 years who resided in Olmsted County between January 1, 1996 and June 30, 2017, and who received diagnoses of seizures, cardiomyopathy, cardiac arrest, respiratory arrest, laryngospasm, and/or tetany. The incidence of hypocalcemia plus a potentially life-threatening complication was calculated.

Results: Among 15 419 patients aged 0-5 years in Olmsted County during the study period, 1305 had eligible complications: 460 had serum calcium checked within 14 days of presentation and 85 had hypocalcemia. Patients were excluded when causes other than hypocalcemia likely triggered the complication, leaving 16 children whose complication was attributed to hypocalcemia. Three of these 16 patients had a serum 25-hydroxyvitamin D measurement and 2 were deficient (≤6 ng/mL [15 nmol/L]). Among children aged 0-5 years, the incidence of hypocalcemia plus a potentially life-threatening complication was 6.1 per 100 000 person-years (95% CI, 3.5-10.0).

Conclusions: Vitamin D deficiency is an underinvestigated cause of complications of hypocalcemia in children. Serum calcium and 25-hydroxyvitamin D should be measured in children with these complications to identify possibly life-threatening vitamin D deficiency.

Keywords: 25-hydroxyvitamin D; calcium; cardiac arrest; cardiomyopathy; laryngospasm; respiratory arrest; seizure; tetany.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Calcium / blood
  • Cardiomyopathies / complications
  • Cardiomyopathies / epidemiology
  • Child, Preschool
  • Data Collection
  • Electronic Health Records
  • Female
  • Heart Arrest / complications
  • Heart Arrest / epidemiology
  • Humans
  • Hypocalcemia / complications*
  • Hypocalcemia / epidemiology
  • Incidence
  • Infant
  • Infant, Newborn
  • Laryngismus / complications
  • Laryngismus / epidemiology
  • Male
  • Minnesota
  • Respiratory Insufficiency / complications
  • Respiratory Insufficiency / epidemiology
  • Seizures / complications
  • Seizures / epidemiology
  • Tetany / complications
  • Tetany / epidemiology
  • Vitamin D / analogs & derivatives
  • Vitamin D / blood
  • Vitamin D Deficiency / complications*
  • Vitamin D Deficiency / epidemiology


  • Vitamin D
  • 25-hydroxyvitamin D
  • Calcium