title: Afebrile seizures and electrocardiography abnormality: an unusual presentation of nutritional rickets.
abstract: BACKGROUND
  Nutritional rickets is not uncommon in the western world and has been reported widely. Occasionally, children have presented to paediatrics with afebrile seizures secondary to hypocalcaemia due to hypovitaminosis D. However, association of nutritional rickets with electrocardiography changes and prolonged QT interval is not well documented. It is a rare, potentially serious and yet easy-to-treat complication as shown in our case. Our case also highlights the importance of awareness and education of both parents and clinicians regarding this relatively common but easily treatable condition.
  
  
  METHODS
  We report a case of undiagnosed nutritional rickets presenting as 'Afebrile' seizure in a seven-month-old Somali girl. Her initial blood work-up showed low ionised calcium (0.8 mmol/l) on blood gas sampling, confirmed by laboratory result (adjusted 1.49 mmol/l). She had prolonged QTc on electrocardiography which reverted to normal with treatment. She was treated with intravenous as well as oral calcium after which she had no further seizures. We present a unique case of nutritional rickets-associated hypocalcaemia.
  
  
  CONCLUSIONS
  This case highlights the resurgence of nutritional rickets in western societies. We need to keep this disease in our list of diagnoses as it is a potentially serious and yet easily treatable disease. We should be more vigilant for screening ethnic minorities as alarmingly high rates of hypovitaminosis D have been found in ethnic minorities living in Great Britain.
authors.affiliation: General Paediatric Registrar, Department of Paediatrics, University Hospital Bristol NHS Foundation Trust, UK.
authors.forename: Kg
authors.initials: K
authors.lastname: Gad
authors.affiliation: Paediatric Registrar, Department of Paediatric Dermatology, Great Ormand Street Hospital for Children, UK.
authors.forename: Ma
authors.initials: M
authors.lastname: Khan
authors.affiliation: Paediatric Registrar, Department of Paediatric Rheumatology, University Hospital Bristol, NHS Foundation Trust, UK drkaykay@gmail.com.
authors.forename: K
authors.initials: K
authors.lastname: Mahmood
mesh_terms: D004562:Electrocardiography; D005260:Female; D006801:Humans; D007223:Infant; D011859:Radiography; D012279:Rickets / Q000150:complications / Q000175:diagnosis*; D012640:Seizures / Q000209:etiology*; D014953:Wrist / Q000000981:diagnostic imaging
keywords: ECG changes; Hypocalcaemia; rickets; seizure; tetany