Hypovitaminosis D-related myopathy in immigrant teenagers.

INTRODUCTION: Vitamin D deficiency resulting in a limb-girdle muscle weakness was diagnosed in three veiled immigrant teenage girls. PATIENTS: Three girls had a progressive muscle weakness and pain during a period varying from 6 months to two years. On examination limb girdle muscle weakness, predominantly of the lower extremities, without other neurological abnormalities was found. Serum examination showed a decreased level of vitamin D and phosphate and an increased alkaline phosphatase, and in two girls decreased calcium and increased parathyroid hormone levels were found. After supplementation with vitamin D, the pain subsided and muscle strength increased within weeks. Serum examination of the female relatives revealed eight persons with hypovitaminosis D, without any complaints. CONCLUSIONS: Vitamin D deficiency can result in a limb-girdle myopathy in veiled immigrant teenagers in the Netherlands. Vitamin D supplementation leads to rapid recovery of the muscle strength. The female relatives of these patients should be examined too.

Maternal-fetal effects of magnesium sulfate on serum osmolality in pre-eclampsia.

OBJECTIVE: To determine the effects of magnesium sulfate therapy on maternal and fetal osmolality in pre-eclampsia. METHODS: A total of 34 pre-eclamptic women and 22 normal pregnant women participated in the study. Venous blood was drawn upon admission to the labor and delivery unit. Pre-eclamptic patients received standard magnesium sulfate therapy and had a second sample of venous blood drawn 4 h following the beginning of therapy. Fetal umbilical vein blood was obtained immediately following delivery in both groups. Osmolality was measured using a vapor pressure osmometer. Electrolyte levels were measured with a NOVA 8 biomedical analyzer. Data were analyzed via Student's t test, linear regression and correlation with significance established at p < 0.05. RESULTS: We found no significant difference between the maternal osmolalities of the control and pre-eclamptic groups. Interestingly, fetal cord blood osmolality was significantly lower than maternal osmolality in the normal pregnant women. Sodium levels were also lower, while potassium and ionized calcium levels were higher in the fetal blood. In women with pre-eclampsia treated with magnesium sulfate, there was no difference between the osmolality of the maternal and fetal blood, while potassium and ionized calcium levels were still higher in the fetal blood. Finally, we found no correlation between maternal osmolality and blood pressure. CONCLUSIONS: High blood pressure in pre-eclampsia is not associated with altered osmolality. An absence of the normal decrease in fetal osmolality is observed in pre-eclamptic women treated with magnesium sulfate.