3 days old neonate product of full term normal vaginal delivery, birth weight 2.9 kg, admitted with CoA severe LV dysfunction. Investigations showed thrombocytopenia, grossly deranged liver enzymes (SGOT-1388, SGPT-144, ALP-1023), serum calcium 7 mg/dl, metabolic acidosis, and ionized calcium 0.8 mmol/l. He underwent CoA repair on day of admission and was discharged on 10th postop day with well-opened repaired arch (PG-12 mmHg) and normal ventricular function. 2 months follow up echo showed LV dysfunction (EF-40%), total gradient in arch 24 mmHg, no diastolic spilling. Cardiac catheterisation showed well opened repaired arch and total gradient of 8 mmHg across arch. With these findings all blood investigations were critically analyzed again. There was only one report showing hypocalcemia though ionized calcium was not very low as there was metabolic acidosis. During ICU stay baby received calcium infusion and so rest ABG showed normal ionized calcium. With this possibility, he was screened for hypocalcemia. Baby was on top feed, lab investigations showed serum calcium 8 mg/dl, Alkaline Phosphatase-2217 U/L, serum Magnesium 2.2 mg/dl. Vitamin D3 level and serum parathyroid harmone levels were not done due to financial constrains. He was treated with therapeutic dose of vitamin D (Inj Arachitol 6 lac IMI single dose), maintenance vitamin D oral (400 IU),oral calcium (100 mg/kg/day) .Follow up echocardiography after 3 months showed normal ventricular function
Conclusion: Hypocalcaemia, though uncommon, is a reversible cause of cardiac decompensation and should be looked for in all patients with myocardial dysfunction.