Research Article
BibTex RIS Cite

Febril Konvülziyonlu Çocuklarda Serum Kalsiyum Düzeyleri, Eritrosit İndeksleri ve İlişkili Faktörler

Year 2025, Volume: 4 Issue: 2, 17 - 26, 30.06.2025

Sevim Şahin , Nihal Yıldız , Gülnur Esenülkü , Pınar Özkan Kart , Tulay Kamasak , Ahmet Kağan Özkaya , Süleyman Caner Karahan , Ali Cansu

https://doi.org/10.59518/farabimedj.1590060

Abstract

Febril konvülziyonlar (FK), çocukluk çağının en sık nöbetleridir. Çoğu çalışmada, FK ile demir eksikliği arasında ilişki bulunurken serum kalsiyum (Ca) düzeylerine ilişkin sonuçlar çelişkilidir. Bu çalışmada, eritrosit indeksleri, serum Ca düzeyleri ve bunu etkileyebilecek faktörlerin FK’daki tutulumu incelenmiştir. Prospektif olarak, altı ay-beş yaş arası hastalar komplike FK (n = 23), basit FK (n = 22) ve nöbet olmaksızın ateşli kontrol grubuna (n = 25) alındı. Merkezi sinir sistemi enfeksiyonu, afebril nöbet öyküsü ve kronik ilaç kullanımı olanlar dışlandı. Serumda total ve iyonize Ca, inorganik fosfat, D vitamin düzeyleri, kanda eritrosit sayısı ve indeksleri, hemoglobin, hematokrit, pH, bikarbonat ve laktat düzeyleri incelendi. FK ve kontrol grubu ayrımında verilerin optimal kesme değerlerinin belirlenmesinde ‘alıcı çalışma karakteristiği’ analizi kullanıldı. Komplike FK grubunda Ca ve ortalama korpüsküler hemoglobin konsantrasyonu (MCHC) düzeyi kontrol grubuna göre düşük (her ikisi için p = 0.004), albümin düzeyi basit FK grubuna göre düşüktü (p = 0.02). Ca ve MCHC düzeyleri arasında pozitif korelasyon saptandı (r = 0.252, p = 0.039). FK grubunda, MCHC < 34.1 g/dL, Ca < 9.9 mg/dL, iyonize Ca < 1.27 mmol/L ve pH < 7.38 olanların oranı daha sıktı (sırasıyla p = 0.003, p = 0.005, p = 0.044 ve p = 0.035). Kalsiyum ve MCHC düzeylerinin düşüklüğü ile FK arasında anlamlı ilişki saptandı. Kalsiyum ve MCHC düzeyleri arasındaki anlamlı pozitif korelasyon, bu bulguların ortak patogenetik mekanizması olabileceğini düşündürmektedir. Kan pH seviyesi düşük olanların oranındaki anlamlı artış, bildiğimiz kadarıyla FK ile ilişkili yeni bir bulgudur.

Keywords

D vitamini Febril konvülziyon Kalsiyum Kan pH MCHC

References

  • Steering Committee on Quality Improvement and Management, Subcommittee on Febrile Seizures American Academy of Pediatrics. Febrile seizures: clinical practice guideline for the long-term management of the child with simple febrile seizures. Pediatrics. 2008;121(6):1281-1286.
  • Sawires R, Buttery J, Fahey M. A review of febrile seizures: Recent advances in understanding of febrile seizure pathophysiology and commonly implicated viral triggers. Front Pediatr. 2022;9:801321.
  • Saghazadeh A, Mastrangelo M, Rezaei N. Genetic background of febrile seizures. Rev Neurosci. 2014;25(1):129-161.
  • Hamroun A, Pekar JD, Lionet A, et al. Ionized calcium: analytical challenges and clinical relevance. J Lab Precis Med. 2020;5:1-16.
  • Han P, Trinidad BJ, Shi J. Hypocalcemia-induced seizure: demystifying the calcium paradox. ASN Neuro. 2015;7(2):1759091415578050.
  • Chen R, Li S, Wang X, Zhou J, Lu Y, Kang A. Analysis of cytokines and trace elements in children with febrile seizures. Transl Pediatr. 2020;9(6):809-817.
  • Fleet JC. Vitamin D-mediated regulation of intestinal calcium absorption. Nutrients. 2022;14(16):3351.
  • Ushakiran CB. Suresh R. Reduced serum calcium is a risk factor for febrile seizures. Int J Contemp Pediatr. 2017;4(4):1506-1508.
  • Akbayram S, Cemek M, Büyükben A, et al. Major and minor bio-element status in children with febrile seizure. Bratisl Lek Listy. 2012;113(7):421-423.
  • Shajari H, Shajari A, Azizkhan H, Barzegari R. Correlation of serum ferritin and calcium level with febrile seizures: A hospital-based prospective case-control study. Maedica (Bucur). 2021;16(3):420-425.
  • Naseer MR, Patra KC. Correlation of serum iron and serum calcium levels in children with febrile seizures. Int J Contemp Pediatr. 2015;2(4):406-410.
  • Papageorgiou V, Vargiami E, Kontopoulos E, et al. Association between iron deficiency and febrile seizures. Eur J Paediatr Neurol. 2015;19(5):591-596.
  • Kwak BO, Kim K, Kim SN, Lee R. Relationship between iron deficiency anemia and febrile seizures in children: A systematic review and meta-analysis. Seizure. 2017;52:27-34.
  • Özdemir N. Iron deficiency anemia from diagnosis to treatment in children. Turk Pediatri Ars. 2015;50(1):11-19.
  • Francis JR, Richmond P, Robins C, et al. An observational study of febrile seizures: the importance of viral infection and immunization. BMC Pediatr. 2016;16(1):202.
  • Chiarelli F, De Palma C, Verrotti A, Lombardi G, Domizio S. Electrolytic changes in febrile convulsions. Pediatr Med Chir. 1985;7(2):249-252.
  • Mohammadi M, Baleghi Y, Salehiomran M, et al. Evaluation of vitamin D level in children with febrile seizure referred to amirkola children's hospital, babol. Glob Pediatr Health. 2023;10:2333794X231198390.
  • Heydarian F, Bakhtiari E, Golmakani H, Fakhr Ghasemi N, Heidarian M. Serum level of vitamin D and febrile seizure? A clinical study. Iran J Child Neurol. 2020;14(3):77-82.
  • Bağcı Z. Comparison of serum vitamin D levels in febrile children with and without seizure. Bozok Med J. 2021;11(3):1-6.
  • Güneş A, Fidan S, Dulkadir R, Ünlü E. Evaluation of risk factors associated with first episode febrile seizure. Eur Rev Med Pharmacol Sci. 2021;25(22):7089-7092.
  • Tütüncüoğlu S, Kütükçüler N, Kepe L, Coker C, Berdeli A, Tekgül H. Proinflammatory cytokines, prostaglandins and zinc in febrile convulsions. Pediatr Int. 2001;43(3):235-239.
  • Mirsaeidi M, Omar HR, Sweiss N. Hypoalbuminemia is related to inflammation rather than malnutrition in sarcoidosis. Eur J Intern Med. 2018;53:e14-e16.
  • Şahin S, Uysal S, Yentür SP, Kaçar A. Reduced cerebrospinal fluid levels of interleukin-10 in children with febrile seizures. Seizure. 2019;65:94-97.
  • Polat I, Karaoglu P, Ayanoglu M, et al. Inflammation and anemia in simple febrile seizures and complex febrile seizures. Ann Med Res. 2021;28:1835-1839.
  • Zhou X, Chen D, Wang L, et al. Low serum calcium: A new, important indicator of COVID-19 patients from mild/moderate to severe/critical. Biosci Rep. 2020;40:1–8.
  • Mao S, Wu L, Shi W. Calcium, phosphorus, magnesium levels in frequent respiratory tract infections. Ann Med. 2023;55(2):2304661.
  • Hendy GN, Canaff L. Calcium-Sensing Receptor Gene: Regulation of Expression. Front Physiol. 2016;7:394.
  • Ginde AA, Mansbach JM, Camargo CA Jr. Association between serum 25-hydroxyvitamin D level and upper respiratory tract infection in the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2009;169(4):384-390.
  • Mandal SK, De S, Das R, Awati NJ, Dey N, Biswas A. Evaluating the association between iron deficiency anemia and febrile convulsion among children aged 6–60 months admitted to a tertiary care hospital in eastern India: a case-control study. Cureus. 2024;16(4):e58761.
  • Sulviani R, Kamarullah W, Dermawan S, Susanto H. Anemia and poor iron indices are associated with susceptibility to febrile seizures in children: A systematic review and meta-analysis. J Child Neurol. 2023;38(3-4):186-197.
  • Papež J, Labounek R, Jabandžiev P, et al. Multivariate linear mixture models for the prediction of febrile seizure risk and recurrence: a prospective case-control study. Sci Rep. 2023;13(1):17372.
  • Jang HN, Yoon HS, Lee EH. Prospective case control study of iron deficiency and the risk of febrile seizures in children in South Korea. BMC Pediatr. 2019;19(1):309.
  • Bakkannavar S, Faheem Y, Jaiswal A, et al. Associative patterns between iron deficiency anemia and febrile seizures in the five to 60 months age group: A comprehensive systematic review. Cureus. 2024;16(3):e56470.
  • Kamalammal R, Balaji MD. Association between iron deficiency anemia and various red cell parameters with febrile convulsions in children of age group 3 to 60 months. Int J Contemp Pediatr. 2016;3(2):559-562.
  • Foucher CD, Tubben RE. Lactic Acidosis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.
  • Lee D, Moon HJ, Lee HJ, Jeong D, Kim HJ, Noh H, et al. Role of lactate measurement in predicting recurrence of seizure within 24 hours in simple febrile seizure patients. Signa Vitae. 2023;19(3):188-194.
  • Schuchmann S, Hauck S, Henning S, et al. Respiratory alkalosis in children with febrile seizures. Epilepsia. 2011;52(11):1949-1955.
  • Finch CA, Gollnick PD, Hlastala MP, Miller LR, Dillmann E, Mackler B. Lactic acidosis as a result of iron deficiency. J Clin Invest. 1979;64(1):129-137.
  • Zhang S, Liu W, Ganz T, Liu S. Exploring the relationship between hyperlactatemia and anemia. Trends Endocrinol Metab. 2024;35(4):300-307.
  • Alexander RT, Cordat E, Chambrey R, Dimke H, Eladari D. Acidosis and urinary calcium excretion: insights from genetic disorders. J Am Soc Nephrol. 2016;27(12):3511-3520.
  • Papadimitriou A, Nicolaidou P, Garoufi A, Georgouli H, Karpathios T. Hypercalciuria in children with febrile convulsions. Pediatr Int. 2001;43(3):231-234.
  • Sipahi T, Köksal T, Tavil B, Akar N. The effects of acute infection on hematological parameters. Pediatr Hematol Oncol. 2004;21(6):513-520.
  • Weiss G, Ganz T, Goodnough LT. Anemia of inflammation. Blood. 2019;133(1):40-50.
  • Nairz M, Theurl I, Wolf D, Weiss G. Iron deficiency or anemia of inflammation? Differential diagnosis and mechanisms of anemia of inflammation. Wien Med Wochenschr. 2016;166(13-14):411-423.
  • Liu Q, Dang AM, Chen BW, Lv NQ, Wang X, Zheng DY. The association of red blood cell distribution width with anemia and inflammation in patients with Takayasu arteritis. Clin Chim Acta. 2015;438:205-209.
  • Sharma S, Singh N, Thimmaraju KV, Tilak M. Assessment of ionized calcium status in febrile seizures. Int J Clin Biomed Res. 2018;4(1):35-37.
  • Sakha K, Barzegar M. Evaluation of serum sodium and ionized calcium levels in febrile convulsions. Med J Tabriz Univ Med Sci. 2005;27(1):33-36.

Serum Calcium Levels, Erythrocyte Indices, and Associated Factors in Children with Febrile Seizures

Year 2025, Volume: 4 Issue: 2, 17 - 26, 30.06.2025

Sevim Şahin , Nihal Yıldız , Gülnur Esenülkü , Pınar Özkan Kart , Tulay Kamasak , Ahmet Kağan Özkaya , Süleyman Caner Karahan , Ali Cansu

https://doi.org/10.59518/farabimedj.1590060

Abstract

Febrile seizures (FS) are the most common seizures in childhood. In most studies, iron deficiency was associated with FS, whereas serum calcium (Ca) levels were contradictory. This study evaluated the relationships of erythrocyte indices, serum Ca levels, and related factors among children with FS. Prospectively, patients aged six months to five years were included in the complex FS (n = 23), simple FS (n = 22) and febrile without seizure groups (n = 25). Patients with central nervous system infection, previous afebrile seizures, or chronic drug use were excluded. Total and ionized Ca, inorganic phosphate, vitamin D levels, erythrocyte count and indices, hemoglobin, hematocrit, pH, bicarbonate and lactate levels in blood were examined. The cutoff values of variables discriminating between the FS and control groups were established through receiver operating characteristic analysis. In the complex FS group, Ca and mean corpuscular hemoglobin concentration (MCHC) levels were lower than those in the control group (p = 0.004 for both) and albumin levels were lower than those in the simple FS group (p = 0.02). Ca levels were positively correlated with MCHC (r = 0.252, p = 0.039). In the FS group, the proportions of MCHC < 34.1 g/dL, Ca < 9.9 mg/dL, ionized Ca < 1.27 mmol/L and pH < 7.38 were more frequent (p = 0.003, p = 0.005, p = 0.044 and p = 0.035 respectively). Lower Ca and MCHC levels were associated with FS. The positive correlation between Ca and MCHC levels indicates a common pathogenetic mechanism. To our knowledge, the increased proportion of patients with low blood pH level in FS is a novel finding.

Keywords

Blood pH Calcium Febrile seizure MCHC Vitamin D

Ethical Statement

The prospective study was initiated after receiving approval from the local ethics committee. The study protocol was approved by the Local Ethics Committee of Karadeniz Technical University (Protocol Number: 2019/57).

References

  • Steering Committee on Quality Improvement and Management, Subcommittee on Febrile Seizures American Academy of Pediatrics. Febrile seizures: clinical practice guideline for the long-term management of the child with simple febrile seizures. Pediatrics. 2008;121(6):1281-1286.
  • Sawires R, Buttery J, Fahey M. A review of febrile seizures: Recent advances in understanding of febrile seizure pathophysiology and commonly implicated viral triggers. Front Pediatr. 2022;9:801321.
  • Saghazadeh A, Mastrangelo M, Rezaei N. Genetic background of febrile seizures. Rev Neurosci. 2014;25(1):129-161.
  • Hamroun A, Pekar JD, Lionet A, et al. Ionized calcium: analytical challenges and clinical relevance. J Lab Precis Med. 2020;5:1-16.
  • Han P, Trinidad BJ, Shi J. Hypocalcemia-induced seizure: demystifying the calcium paradox. ASN Neuro. 2015;7(2):1759091415578050.
  • Chen R, Li S, Wang X, Zhou J, Lu Y, Kang A. Analysis of cytokines and trace elements in children with febrile seizures. Transl Pediatr. 2020;9(6):809-817.
  • Fleet JC. Vitamin D-mediated regulation of intestinal calcium absorption. Nutrients. 2022;14(16):3351.
  • Ushakiran CB. Suresh R. Reduced serum calcium is a risk factor for febrile seizures. Int J Contemp Pediatr. 2017;4(4):1506-1508.
  • Akbayram S, Cemek M, Büyükben A, et al. Major and minor bio-element status in children with febrile seizure. Bratisl Lek Listy. 2012;113(7):421-423.
  • Shajari H, Shajari A, Azizkhan H, Barzegari R. Correlation of serum ferritin and calcium level with febrile seizures: A hospital-based prospective case-control study. Maedica (Bucur). 2021;16(3):420-425.
  • Naseer MR, Patra KC. Correlation of serum iron and serum calcium levels in children with febrile seizures. Int J Contemp Pediatr. 2015;2(4):406-410.
  • Papageorgiou V, Vargiami E, Kontopoulos E, et al. Association between iron deficiency and febrile seizures. Eur J Paediatr Neurol. 2015;19(5):591-596.
  • Kwak BO, Kim K, Kim SN, Lee R. Relationship between iron deficiency anemia and febrile seizures in children: A systematic review and meta-analysis. Seizure. 2017;52:27-34.
  • Özdemir N. Iron deficiency anemia from diagnosis to treatment in children. Turk Pediatri Ars. 2015;50(1):11-19.
  • Francis JR, Richmond P, Robins C, et al. An observational study of febrile seizures: the importance of viral infection and immunization. BMC Pediatr. 2016;16(1):202.
  • Chiarelli F, De Palma C, Verrotti A, Lombardi G, Domizio S. Electrolytic changes in febrile convulsions. Pediatr Med Chir. 1985;7(2):249-252.
  • Mohammadi M, Baleghi Y, Salehiomran M, et al. Evaluation of vitamin D level in children with febrile seizure referred to amirkola children's hospital, babol. Glob Pediatr Health. 2023;10:2333794X231198390.
  • Heydarian F, Bakhtiari E, Golmakani H, Fakhr Ghasemi N, Heidarian M. Serum level of vitamin D and febrile seizure? A clinical study. Iran J Child Neurol. 2020;14(3):77-82.
  • Bağcı Z. Comparison of serum vitamin D levels in febrile children with and without seizure. Bozok Med J. 2021;11(3):1-6.
  • Güneş A, Fidan S, Dulkadir R, Ünlü E. Evaluation of risk factors associated with first episode febrile seizure. Eur Rev Med Pharmacol Sci. 2021;25(22):7089-7092.
  • Tütüncüoğlu S, Kütükçüler N, Kepe L, Coker C, Berdeli A, Tekgül H. Proinflammatory cytokines, prostaglandins and zinc in febrile convulsions. Pediatr Int. 2001;43(3):235-239.
  • Mirsaeidi M, Omar HR, Sweiss N. Hypoalbuminemia is related to inflammation rather than malnutrition in sarcoidosis. Eur J Intern Med. 2018;53:e14-e16.
  • Şahin S, Uysal S, Yentür SP, Kaçar A. Reduced cerebrospinal fluid levels of interleukin-10 in children with febrile seizures. Seizure. 2019;65:94-97.
  • Polat I, Karaoglu P, Ayanoglu M, et al. Inflammation and anemia in simple febrile seizures and complex febrile seizures. Ann Med Res. 2021;28:1835-1839.
  • Zhou X, Chen D, Wang L, et al. Low serum calcium: A new, important indicator of COVID-19 patients from mild/moderate to severe/critical. Biosci Rep. 2020;40:1–8.
  • Mao S, Wu L, Shi W. Calcium, phosphorus, magnesium levels in frequent respiratory tract infections. Ann Med. 2023;55(2):2304661.
  • Hendy GN, Canaff L. Calcium-Sensing Receptor Gene: Regulation of Expression. Front Physiol. 2016;7:394.
  • Ginde AA, Mansbach JM, Camargo CA Jr. Association between serum 25-hydroxyvitamin D level and upper respiratory tract infection in the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2009;169(4):384-390.
  • Mandal SK, De S, Das R, Awati NJ, Dey N, Biswas A. Evaluating the association between iron deficiency anemia and febrile convulsion among children aged 6–60 months admitted to a tertiary care hospital in eastern India: a case-control study. Cureus. 2024;16(4):e58761.
  • Sulviani R, Kamarullah W, Dermawan S, Susanto H. Anemia and poor iron indices are associated with susceptibility to febrile seizures in children: A systematic review and meta-analysis. J Child Neurol. 2023;38(3-4):186-197.
  • Papež J, Labounek R, Jabandžiev P, et al. Multivariate linear mixture models for the prediction of febrile seizure risk and recurrence: a prospective case-control study. Sci Rep. 2023;13(1):17372.
  • Jang HN, Yoon HS, Lee EH. Prospective case control study of iron deficiency and the risk of febrile seizures in children in South Korea. BMC Pediatr. 2019;19(1):309.
  • Bakkannavar S, Faheem Y, Jaiswal A, et al. Associative patterns between iron deficiency anemia and febrile seizures in the five to 60 months age group: A comprehensive systematic review. Cureus. 2024;16(3):e56470.
  • Kamalammal R, Balaji MD. Association between iron deficiency anemia and various red cell parameters with febrile convulsions in children of age group 3 to 60 months. Int J Contemp Pediatr. 2016;3(2):559-562.
  • Foucher CD, Tubben RE. Lactic Acidosis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.
  • Lee D, Moon HJ, Lee HJ, Jeong D, Kim HJ, Noh H, et al. Role of lactate measurement in predicting recurrence of seizure within 24 hours in simple febrile seizure patients. Signa Vitae. 2023;19(3):188-194.
  • Schuchmann S, Hauck S, Henning S, et al. Respiratory alkalosis in children with febrile seizures. Epilepsia. 2011;52(11):1949-1955.
  • Finch CA, Gollnick PD, Hlastala MP, Miller LR, Dillmann E, Mackler B. Lactic acidosis as a result of iron deficiency. J Clin Invest. 1979;64(1):129-137.
  • Zhang S, Liu W, Ganz T, Liu S. Exploring the relationship between hyperlactatemia and anemia. Trends Endocrinol Metab. 2024;35(4):300-307.
  • Alexander RT, Cordat E, Chambrey R, Dimke H, Eladari D. Acidosis and urinary calcium excretion: insights from genetic disorders. J Am Soc Nephrol. 2016;27(12):3511-3520.
  • Papadimitriou A, Nicolaidou P, Garoufi A, Georgouli H, Karpathios T. Hypercalciuria in children with febrile convulsions. Pediatr Int. 2001;43(3):231-234.
  • Sipahi T, Köksal T, Tavil B, Akar N. The effects of acute infection on hematological parameters. Pediatr Hematol Oncol. 2004;21(6):513-520.
  • Weiss G, Ganz T, Goodnough LT. Anemia of inflammation. Blood. 2019;133(1):40-50.
  • Nairz M, Theurl I, Wolf D, Weiss G. Iron deficiency or anemia of inflammation? Differential diagnosis and mechanisms of anemia of inflammation. Wien Med Wochenschr. 2016;166(13-14):411-423.
  • Liu Q, Dang AM, Chen BW, Lv NQ, Wang X, Zheng DY. The association of red blood cell distribution width with anemia and inflammation in patients with Takayasu arteritis. Clin Chim Acta. 2015;438:205-209.
  • Sharma S, Singh N, Thimmaraju KV, Tilak M. Assessment of ionized calcium status in febrile seizures. Int J Clin Biomed Res. 2018;4(1):35-37.
  • Sakha K, Barzegar M. Evaluation of serum sodium and ionized calcium levels in febrile convulsions. Med J Tabriz Univ Med Sci. 2005;27(1):33-36.
There are 47 citations in total.

Details

Primary Language English
Subjects Clinical Sciences (Other)
Journal Section Research Articles
Authors

Sevim Şahin 0000-0001-5415-5874

Nihal Yıldız 0000-0003-0989-842X

Gülnur Esenülkü 0000-0002-9423-6078

Pınar Özkan Kart 0000-0001-5726-737X

Tulay Kamasak 0000-0002-5212-0149

Ahmet Kağan Özkaya 0000-0003-3562-6495

Süleyman Caner Karahan 0000-0001-5091-081X

Ali Cansu 0000-0002-1930-6312

Early Pub Date June 29, 2025
Publication Date June 30, 2025
Submission Date November 23, 2024
Acceptance Date February 7, 2025
Published in Issue Year 2025 Volume: 4 Issue: 2

Cite

AMA Şahin S, Yıldız N, Esenülkü G, Özkan Kart P, Kamasak T, Özkaya AK, Karahan SC, Cansu A. Serum Calcium Levels, Erythrocyte Indices, and Associated Factors in Children with Febrile Seizures. Farabi Med J. June 2025;4(2):17-26. doi:10.59518/farabimedj.1590060
 Download Cover Image

*The articles to be sent to the journal should be prepared according to the sample files given below. Manuscripts not prepared in accordance with the journal format will be returned to the Author(s).

1. ORIGINAL ARTICLE TEMPLATE/ÖZGÜN MAKALE ŞABLONU

2. CASE REPORT TEMPLATE/OLGU SUNUMU ŞABLONU

3. REVIEW TEMPLATE /DERLEME ŞABLONU

4. TITLE PAGE/BAŞLIK SAYFASI

5. COPYRIGHT TRANSFER FORM/TELİF HAKKI DEVİR FORMU

6. COVER LETTER/KAPAK YAZISI

**International Medical Journals Editorial Board (ICMJE) directive