Neonatal Hypocalcemic Seizures Due to Excessive Maternal Calcium Ingestion


      Hypocalcemia is a common, treatable cause of neonatal seizures. A term girl neonate with no apparent risk factors developed seizures on day 5 of life, consisting of rhythmic twitching of all extremities in a migrating pattern. Physical examination was normal except for jitteriness. Laboratory evaluation was unremarkable except for decreased total and ionized serum calcium levels and an elevated serum phosphorus level. The mother had ingested 3-6 g of calcium carbonate daily during the final 4 months of pregnancy to control morning sickness. The baby's electroencephalogram showed multifocal interictal sharp waves and intermittent electrographic seizures consisting of focal spikes in the left hemisphere accompanied by rhythmic jerking of the right arm and leg. Treatment with intravenous calcium gluconate over several days resulted in cessation of seizures and normalization of serum calcium. The child has remained seizure free and is normal developmentally at 9 years of age. Hypocalcemic seizures in this newborn were likely secondary to excessive maternal calcium ingestion, which led to transient neonatal hypoparathyroidism and hypocalcemia. Inquiry about perinatal maternal medication use should include a search for over-the-counter agents that might not be thought of as “drugs,” as in this case, antacids.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Pediatric Neurology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Jain A.
        • Agarwal R.
        • Sankar M.J.
        • Deorari A.
        • Paul V.K.
        Hypocalcemia in the newborn.
        Ind J Pediatr. 2008; 75: 165-169
        • Thomas T.C.
        • Smith J.M.
        • White P.C.
        • Adhikari S.
        Transient neonatal hypocalcemia: Presentation and outcomes.
        Pediatrics. 2012; 129: e1461-e1467
        • Committee on Dietary Reference Intakes for Calcium and Vitamin D
        Dietary reference intakes for calcium and vitamin D. Food and Nutrition Board, Institute of Medicine.
        National Academy Press, Washington, DC2010
        • Silverstein F.S.
        • Jensen F.E.
        Neonatal seizures.
        Ann Neurol. 2007; 62: 112-120
        • Kossoff E.H.
        • Silvia M.T.
        • Maret A.
        • Carakushansky M.
        • Vining E.P.G.
        Neonatal hypocalcemic seizures: Case report and literature review.
        J Child Neurol. 2002; 17: 236-239
        • Hsu S.C.
        • Levine M.A.
        Perinatal calcium metabolism: physiology and pathophysiology.
        Semin Neonatol. 2004; 9: 23-36
        • Beall D.P.
        • Scofield R.H.
        Milk-alkali syndrome associated with calcium carbonate consumption. Report of 7 patients with parathyroid hormone levels and an estimate of prevalence among patients hospitalized with hypercalcemia.
        Medicine. 1995; 74: 89-96
        • Robertson W.C.
        Calcium carbonate consumption during pregnancy: an unusual cause of neonatal hypocalcemia.
        J Child Neurol. 2002; 17: 853-855
        • Feng Z.
        • Durand D.M.
        Low-calcium epileptiform activity in the hippocampus in vivo.
        J Neurophysiol. 2003; 90: 2253-2260
        • Isaev D.
        • Ivanchick G.
        • Khmyz V.
        • et al.
        Surface charge impact in low-magnesium model of seizure in rat hippocampus.
        J Neurophysiol. 2012; 107: 417-423
        • Su H.
        • Alroy G.
        • Kirson E.D.
        • Yaari Y.
        Extracellular calcium modulates persistent sodium current-dependent burst-firing in hippocampal pyramidal neurons.
        J Neurosci. 2001; 21: 4173-4182
        • Stafstrom C.E.
        Persistent sodium current and its role in epilepsy.
        Epilepsy Curr. 2007; 7: 15-22
      1. Boucetta S, Crochet S, Chauvette S, Seigneur J, Timofeev I. Extracellular Ca(2+) fluctuations in vivo affect after hyperpolarization potential and modify firing patterns of neocortical neurons [e-pub ahead of print]. Exp Neurol doi:10.1016/j.expneurol.2012.12.001, accessed December 12, 2012.

        • Lu B.
        • Zhang Q.
        • Wang H.
        • Wang Y.
        • Nakayama M.
        • Ren D.
        Extracellular calcium controls background current and neuronal excitability via an UNC79-UNC80-NALCN cation channel complex.
        Neuron. 2010; 68: 488-499
        • Lynch B.J.
        • Rust R.S.
        Natural history and outcome of neonatal hypocalcemic and hypomagnesemic seizures.
        Pediatr Neurol. 1994; 11: 23-27