RestoredCDC.org Comparison

    Original site: www.cdc.gov/mmwr/volumes/70/wr/mm7033a4.htm | RestoredCDC.org is an independent project, not affiliated with CDC or any federal entity. Visit CDC.gov for free official information. Due to archival on January 6, 2025, recent outbreak data is unavailable. Videos are not restored. Access data.restoredcdc.org for restored data. Use of this site implies acceptance of this disclaimer.
    [More]
    About Us Report Bug Compare Content
  Skip directly to search
  Español | Other Languages
    Here's how you know
    An official website of the United States government Here's how you know
        Morbidity and Mortality Weekly Report (MMWR)
        Morbidity and Mortality Weekly Report (MMWR)
        Centers for Disease Control and Prevention. CDC twenty four seven. Saving Lives, Protecting People Morbidity and Mortality Weekly Report (MMWR)
          Search
            Search Menu Navigation Menu
                Submit
    Morbidity and Mortality Weekly Report (MMWR)
      * MMWR
      * Reports by Topic
      * Publications
              + BACK
                Publications
          + Weekly Report
                  o BACK
                    Weekly Report
                  o BACK
                    Publications Weekly Report
              o Past Volumes (1982-2023)
              o Past Volumes (1982-2024)
              o Morbidity and Mortality Weekly Report (MMWR) Home
          + Recommendations and Reports
                  o BACK
                    Recommendations and Reports
                  o BACK
                    Publications Recommendations and Reports
              o Past Volumes (1990-2022)
              o Morbidity and Mortality Weekly Report (MMWR) Home
          + Surveillance Summaries
                  o BACK
                    Surveillance Summaries
                  o BACK
                    Publications Surveillance Summaries
              o Past Volumes (1983-2023)
              o Past Volumes (1983-2024)
              o Morbidity and Mortality Weekly Report (MMWR) Home
          + Supplements
                  o BACK
                    Supplements
                  o BACK
                    Publications Supplements
              o Past Volumes (1985-2023)
              o Morbidity and Mortality Weekly Report (MMWR) Home
          + Archive (1952-1981)
          + Notifiable Infectious Diseases
          + Notifiable Noninfectious Conditions
          + Morbidity and Mortality Weekly Report (MMWR) Home
      * Vital Signs
      * Visual Abstracts
      * Podcasts
      * Continuing Education
      * MMWR Clinical Pearls
      * Metrics
      * For Authors
      * About
              + BACK
                About
          + Staff
          + Editorial Board
          + Morbidity and Mortality Weekly Report (MMWR) Home
      * Subscribe
              + BACK
                Subscribe
          + RSS Feed
          + Morbidity and Mortality Weekly Report (MMWR) Home
      * Morbidity and Mortality Weekly Report (MMWR) Home
          Morbidity and Mortality Weekly Report (MMWR)
    Morbidity and Mortality Weekly Report (MMWR) Home
      Notes from the Field: Vitamin D–Deficient Rickets and Severe Hypocalcemia in Infants Fed Homemade Alkaline Diet Formula — Three States, August 2020–February 2021
        Weekly / August 20, 2021 / 70(33);1124–1125
        Print
            Related Pages
            Diane P. Calello1,2; Mohamed Jefri1,2; Melissa Yu3; Joseph Zarraga3; David Bergamo4; Richard Hamilton3,5 (View author affiliations)
            View suggested citation
                Article Metrics
                Altmetric:
                      See more details
                           News (83)
                           Blogs (1)
                           Policy documents (1)
                           X (53)
                           Facebook (2)
                           Video (1)
                             Mendeley (6)
                Citations: 5
                Views: 1,945
                Views: 16,336
                Views equals page views plus PDF downloads
                  Metric Details
                Related Materials
                  * PDF [71K]
            During August 2020–February 2021, three infants were treated in separate emergency departments in New Jersey, Pennsylvania, and Delaware for symptoms related to consumption of a nutritionally deficient homemade formula based on alkaline diet recipes, with resultant severe hypocalcemia and vitamin D–deficient rickets. Homemade infant formulas and vegan diets might be deficient in essential vitamins and nutrients as has been reported for other formulas (1,2).
            Case 1. On January 29, 2021, a male infant aged 4 months experienced respiratory distress at home and became unresponsive. Emergency medical services found the infant to be pale, lethargic, tachycardic, and hypoxemic (oxygen saturation = 80% [normal ≥95%]), and transported him to the hospital, where he experienced several episodes of bradycardia and cardiac arrest despite emergency endotracheal intubation and mechanical ventilation, insertion of a central venous catheter, fluid replacement, and high-dose intravenous calcium. After the infant was successfully resuscitated, computed tomography and magnetic resonance imaging scans indicated that the infant had diffuse hypoxic brain injury. Laboratory evaluation revealed profound electrolyte abnormalities (anion gap acidosis pH: 6.67 [normal = 7.35–7.45], lactate: 8.3 mmol/L [normal = 0.22–2.98 mmol/L], serum sodium: 164 mEq/L [normal = 135–145 mEq/L], potassium: 6.9 mEq/L [normal = 3.5–5.5 mEq/L], and calcium: 4.0 mg/dL [normal = 8.8–10.8 mg/dL]). Radiographs showed diffuse bone demineralization with flaring and irregularities of long-bone metaphyses consistent with rickets. The child had been fed a homemade formula of sea moss (an intended iodine source), hemp seeds, and coconut water for approximately 1 month.
            Case 2. On January 26, 2021, a male infant aged 5 months was treated in an emergency department after experiencing an episode of extremity stiffening, cyanosis, and brief apnea. Laboratory evaluation revealed that serum calcium was 4.5 mg/dL (normal = 8.8–10.8 mg/dL) with elevated alkaline phosphatase and lactate. Radiographs showed diffuse demineralization with fraying metaphyseal contours consistent with rickets. His parents reported transitioning him at age 3 months to a homemade formula made of coconut water, hemp seed hearts, dates, sea moss gel, and alkaline water. He received high-dose intravenous calcium and magnesium and was discharged home after being placed on a diet of commercial infant formula.
            Case 3. On August 7, 2020, a male infant aged 9 months was evaluated after 5 days of irritability. Physical examination revealed weight and length below the third percentile, frontal bossing (prominent, protruding forehead), decreased tone (inability to sit without assistance), and gross and fine motor delays. Laboratory evaluation showed severe hypocalcemia, no detectable vitamin D, and a thyroid stimulating hormone level of 94,600 mU/L (normal = 0.5–5 mU/L). Long-bone radiographs demonstrated frayed metaphyses and tibial bowing. The patient received diagnoses of rickets and iodine deficiency. His parents reported feeding him homemade formula on an alkaline vegan diet consisting of coconut milk, dates, and sea moss, although the sea moss had been discontinued several months earlier. He was treated with iodine and calcium supplementation and was discharged to a long-term care facility.
            Each of these infants had been fed a homemade formula, reported by their parents as the alkaline diet. Recipes associated with this diet, several variations of which can be found online, show it lacks essential vitamins and micronutrients such as vitamin D, calcium, and iodine. CDC and the Food and Drug Administration have issued warnings about the use of homemade infant formula.*,† These three cases highlight the potential for grave consequences (1,2). Parents should be cautioned to avoid this inappropriate substitute for breast milk or commercial infant formula that can cause hypovitaminosis D, hypocalcemic cardiorespiratory failure, and hypothyroidism, resulting in lasting harm and possibly death.
            Human breast milk and commercial infant formula contain vitamins and micronutrients essential for growth and development (3). Infants fed an alternative diet can develop severe deficiencies and experience long-lasting developmental consequences. The Food and Drug Administration has advised parents and caregivers not to feed homemade formulas to infants, and guidance on choosing an infant formula is available from CDC.
            Top
            Corresponding author: Diane P. Calello, diane.calello@rutgers.edu, 973-972-9280.
            Top
            1Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey; 2New Jersey Poison Information and Education System, Newark, New Jersey; 3Crozer-Chester Medical Center, Upland, Pennsylvania; 4AI DuPont Hospital for Children, Wilmington, Delaware; 5Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania.
            Top
              All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.
            Top
              * https://www.fda.gov/food/alerts-advisories-safety-information/fda-advises-parents-and-caregivers-not-make-or-feed-homemade-infant-formula-infants
              † https://www.cdc.gov/nutrition/InfantandToddlerNutrition/formula-feeding/choosing-an-infant-formula.html
            Top
            References
             1. Shohat M, Levy I, Levy Y, Nitzan M. Nutritional complications in an infant fed exclusively on homemade sesame seed emulsion. J Am Coll Nutr 1989;8:167–9 . https://doi.org/10.1080/07315724.1989.10720291 PMID:2708731
             2. Mangels AR, Messina V. Considerations in planning vegan diets: infants. J Am Diet Assoc 2001;101:670–7 . https://doi.org/10.1016/S0002-8223(01)00169-9 PMID:11424546
             3. US Department of Agriculture. US Department of Health and Human Services. Dietary guidelines for Americans, 2020–2025. 9th ed. Washington, DC: US Department of Agriculture, US Department of Health and Human Services; 2020. https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf
            Top
              Suggested citation for this article: Calello DP, Jefri M, Yu M, Zarraga J, Bergamo D, Hamilton R. Notes from the Field: Vitamin D–Deficient Rickets and Severe Hypocalcemia in Infants Fed Homemade Alkaline Diet Formula — Three States, August 2020–February 2021. MMWR Morb Mortal Wkly Rep 2021;70:1124–1125. DOI: http://dx.doi.org/10.15585/mmwr.mm7033a4.
            MMWR and Morbidity and Mortality Weekly Report are service marks of the U.S. Department of Health and Human Services.
            Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.
            References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.
            All HTML versions of MMWR articles are generated from final proofs through an automated process. This conversion might result in character translation or format errors in the HTML version. Users are referred to the electronic PDF version (https://www.cdc.gov/mmwr) and/or the original MMWR paper copy for printable versions of official text, figures, and tables.
            Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.
      View Page In: PDF [71K]
      Last Reviewed: August 19, 2021
        Source: Centers for Disease Control and Prevention
        * Facebook
        * Twitter
        * LinkedIn
        * Syndicate
        * MMWR
        * Reports by Topic
        * Publications plus icon
            + Weekly Report plus icon
                o Past Volumes (1982-2023)
                o Past Volumes (1982-2024)
            + Recommendations and Reports plus icon
                o Past Volumes (1990-2022)
            + Surveillance Summaries plus icon
                o Past Volumes (1983-2023)
                o Past Volumes (1983-2024)
            + Supplements plus icon
                o Past Volumes (1985-2023)
            + Archive (1952-1981)
            + Notifiable Infectious Diseases
            + Notifiable Noninfectious Conditions
        * Vital Signs
        * Visual Abstracts
        * Podcasts
        * Continuing Education
        * MMWR Clinical Pearls
        * Metrics
        * For Authors
        * About plus icon
            + Staff
            + Editorial Board
        * Subscribe plus icon
            + RSS Feed
          Metric Details
          Close
          Views
          View data is collected and posted time period. Page views include both html and pdf views of an article.
              Views since publication
                  * Page Views: 1,876
                  * Page Views: 15,974
                  * Page Downloads: 69
                  * Page Downloads: 362
                  * Total Views: 1,945
                  * Total Views: 16,336
              View Activity
                  First 30 Days Total Views
          Citations: 5
            Altmetrics
              Click a source for Altmetric details
              What is the Altmetric Attention Score?
              The Altmetric Attention Score for a research output provides an indicator of the amount of attention that it has received. The score is derived from an automated algorithm, and represents a weighted count of the amount of attention Altmetric picked up for a research output.
          Close
              * About CDC
              * Contact Us
              * 800-232-4636
              Facebook Twitter Instagram LinkedIn Youtube Pinterest Snapchat
              Facebook Twitter Instagram LinkedIn Youtube Pinterest Snapchat RSS
          * CONTACT CDC
                    Contact Us
                    Call 800-232-4636
                    Email Us
          * ABOUT CDC
                  + About CDC
                  + Jobs
                  + Funding
          * POLICIES
                  + Accessibility
                  + External Links
                  + Privacy
                  + Policies
                  + Web Policies
                  + No Fear Act
                  + FOIA
                  + OIG
                  + No Fear Act
                  + Nondiscrimination
                  + Vulnerability Disclosure Policy
                  + CDC Archive
                  + Public Health Publications
                  + HHS.gov
                  + USA.gov
          * CONNECT WITH US
                    + Facebook
                    + Twitter
                    + Instagram
                    + LinkedIn
                    + Youtube
                    + Pinterest
                    + Snapchat
                    + Email
          * LANGUAGES
                  + Español
                  + 繁體中文
                  + Tiếng Việt
                  + 한국어
                  + Tagalog
                  + Русский
                  + العربية
                  + Kreyòl Ayisyen
                  + Français
                  + Polski
                  + Português
                  + Italiano
                  + Deutsch
                  + 日本語
                  + فارسی
                  + English
          * U.S. Department of Health & Human Services
          * Accessibility
          * External Links
          * Privacy
          * Policies
          * Web Policies
          * FOIA
          * OIG
          * No Fear Act
          * FOIA
          * Nondiscrimination
          * OIG
          * Vulnerability Disclosure Policy
          * CDC Archive
          * Public Health Publications
          * HHS.gov
          * USA.gov
        Content Credential
        ×
        This image was edited or created using GenAI (generative artificial intelligence).
        Our experts review all images in an effort to ensure accuracy and quality before use.
        Learn more about CDC's usage of GenAI.