CONGESTIVE-HEART-FAILURE AS THE FIRST MAN IFESTATION OF HYPOCALCEMIA IN AN INFANT

There have been few reports of congestive heart failure due to severe hypocalcemia in infants. A two-month-old with gradually worsening hear t failure and mucocutaneous pallor was found upon echocardiography to have dilated cardiomyopathy with hypokinesis. There were no structural cardiac abnormalities. The electrocardiogram was suggestive of hypoca lcemia. The serum calcium level was 1.3 mmol/l. Serum phosphate was in creased to 3.25 mmol/l. Other laboratory test abnormalities were consi stent with vitamin D-deficiency rickets. The outcome was favorable aft er 36 hours under intravenous calcium and vitamin D therapy. Severe hy pocalcemia can cause congestive heart failure in infants. Vitamin D-de ficiency rickets is the most common cause of marked hypocalcemia in in fancy. Calcium therapy promptly improves clinical symptoms. Prevention rests on prophylactic vitamin D therapy during pregnancy.