Hypocalcemia
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Transcript of Hypocalcemia
HYPOCALCEMIA
AMRUTHA R
MScNSG
Ionic calcium
• is crucial for many biochemical processes including
• blood coagulation, • neuromuscular excitability, • cell membrane integrity, and• many of the cellular enzymatic activities.
high-risk neonates
• infants of diabetic mothers, • preterm infants and
infants with perinatal asphyxia.
TYPES
Early onset hypocalcemia • which presents within 72 hours
Late onset• hypocalcemia usually presents after 7 days
CALCIUM METABOLISM
• last trimester• Parathyroidhormone (PTH) and calcitonin • Do not cross placenta• PTH related peptide (PTHrP)• regulator of ca balance
Serum calcium (SCa) in the fetus is 10-11 mg/dL at term
(1-2 mg higher as compared to mother).
After birth
• PTH secretion, • Dietary calcium intake,• renal calcium reabsorbtion, • skeletal calcium stores• vitamin D status.• 7.5-8.5 mg/dL in healthy term babies by day
2 of life.
DROP IN CA LEVEL
• CAUSES• hypoparathyroidism, • end organ unresponsiveness to parathyroid
hormone • abnormalities of vitamin Dmetabolism,
hyperphosphatemia,• hypomagnesemia, and hypercalcitonemia
Calcium homeostasis in newborn
• two major compartments• skeleton (99%) • extracellular fluid (1%).
– bound to albumin (40%)– bound to anions 10%– free ionized form(50%)5
Ionized calcium
• biochemical processes including• blood coagulation,• neuromuscular excitability, • cell membrane integrity and function• cellular enzymatic • secretory activity.
Definition
• Hypocalcemia is defined as total serum calcium of less than 7 mg/dL (1.75mmol/L) or ionized calcium less than 4 mg/dL (1 mmol/L) in preterm infants and less than 8 mg/dL (2 mmol/L; total) or <1.2 mmol/L (ionic) in term neonates
Early onset neonatal hypocalcemia
• first 3-4 days of life• CAUSES• Prematurity• Infant of diabetic mother• Perinatal asphyxia• Maternal hyperparathyroidism• IUGR
Screening is recommended in at risk neonates
• 1.Preterm infants born before 32 wks• 2. Infants of diabetic mothers on iv fluids• 3.Infants born after severe perinatal
asphyxia
Time schedule for screening
• 24 and 48 hours of age in at risk babies
Clinical presentation:
• Asymptomatic
• Symptomatic
Symptomatic
• neuromuscular irritability -• myoclonic jerks• jitteriness• exaggerated startle• seizures.
• cardiac involvement like-• tachycardia• heart failure• prolonged QT interval• decreased contractibility
OTHERS
• Apnea • cyanosis,• tachypnoea,• vomiting • laryngospasm
Diagnosis
• Laboratory• Total or ionized serum calcium (total <7
mg/dL or ionized <4.0 mg/dL).• ECG
Treatment of early onset hypocalcemia
• Prophylactic• Preterm infants (£32 weeks), sick infants of
diabetic mothers. severe perinatal asphyxia should receive 40 mg/kg/day of
• elemental calcium (4 mL/kg/day of 10% calcium gluconate)
Asymptomatic hypocalcemia
• 80-mg/kg/day elemental calcium (8 mL/kg/day of 10% calcium gluconate) for 48 hours
Symptomatic hypocalcemia
• bolus dose of 2 mL/kg/dose diluted 1:1 with• 5% dextrose over 10 minutes under cardiac
monitoring• severe hypocalcaemia with poor cardiac
function,• calcium chloride 20 mg/kg may be given
through a central line over 10-30 minutes
• continuous IV infusion of 80 mg/kg/day elemental calcium for 48 hours
• Continuous infusion is preferred to IV bolus doses (1 mL/kg/dose q 6hourly).
Management of early neonatal hypocalcaemia
• Hypocalcemia• Total serum Cal <7 mg/dl
• Asymptomatic• 80 mg/kg/day for 48 hrs
• (8 mL/kg/day of 10% calcium gluconate )
• Taper to 40 mg/kg/day for one day• Then stop
Symptomatic
• Bolus of 2 mL/kg calcium gluconate 1:1 diluted with 5 % dextrose
• over 10 minutes under cardiac monitorin
• Followed by continuous infusion 80 mg/kg/day for 48 hrs
• (8 mL/kg/day of 10% calcium gluconate )• Document normal calcium at 48 hrs
• Then taper to 40 mg/kg/day for one day• Then stop
• Prophylactic• Preterm< 32 wks, sick IDM, severe
asphyxia• 40 mg/kg/day for 3 days
• (4ml/kg/day of 10% calcium gluconate )• IV or oral if can tolerate per oral
• Treatment is for 72 hours• Continuous infusion is better than bolus• Symptomatic babies treatment is 48 hrs
continuous
infusion
Precautions and side effects
• Bradycardia and• arrhythmia• extravasation • subcutaneous tissue necrosis.
Prolonged or resistant hypocalcemia
• Symptomatic hypocalcemia unresponsive to therapy
• · Infants needing calcium supplements beyond 72 hours of age
• · Hypocalcemia presenting at the end of the first week
Late onset neonatal hypocalcemia (LNH)
• symptomatic in the form of neonatal tetany or seizures
• 1. Hypomagnesemia• 0.2 mL/kgof 50% MgSO4 injection, 12 hours
apart, deep IM• Maintenance dose of 0.2 mL/kg/day of 50%
MgSO4, PO for 3 days.
• 2. High phosphate load• 3. Hypoparathyroidism• calcium (50 mg/kg/day in 3 divided doses)
and 1,25(OH)2 Vitamin D3 (0.5-1 mg/day).• 4. Vitamin D deficiency states
HYPOMAGNESEMIA
FunctionsBones teeth muscles nerves
Food to energy
Build proteins
Ca
CAUSES
• Diarrhoea• Suctioning• Chemotherapic drugs
– Cisplatin
• Diuretic therapy• Hyper ca• Malnutrition• Diabetic acidosis• Dehydration
Types
• Primary
• Secondary
CLINICAL FEATURES
• CARDIAC• Arrhythmia• Ecg • HTN• NEUROMUSCULAR MANIFESTATIONS
TREATMENT
• Mg so4• 50% solution• 500 mg• 4mEq/ml• 50—100 ml/kg of Mgso4
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