Hypocalcemia
2002/01(制定) 2007/01(修) Definition:total serum calcaium < 8mg/dl in full term
< 7mg/dl in preterm ionized calcium < 3-3.5 mg/dl Etiology
Early onset (during the first 3 days) Preterm infants
Infants of diabetic mothers
? In utero exposure to anticonvulsants
? Phototherapy
Late onset (at the end of the 1st weeks of life) High dietary phosphate load
Intestinal calcium malabsorption Hypoparathyroidism
Idiopathic, transient
Congenital eg. DiGeorge sequence Maternal hyperparathyroidism Magnesium deficience
Vitamin D deficiency
Maternal vitamin D deficiency Maternal anticonvulsant therapy Renal insufficiency
Hepatobiliary disease Miscellaneous
Exchange blood transfusion (CPD)
Increased free fatty acid (intravenous lipid infusions) Alkalosis
Hyperphosphatemia Hypoalbuminemia Furosemide Shock or sepsis
? in utero exposure to narcotics Clinical manifestions
Asymptomatic
Tremulousness, apnea, cyanosis, seizures Convulsions
Lethargy, feedin poorly, vomiting, abdominal distension
Diagnostic workup History
Familial
Pregnancy (illness, drug, gestation, birth asphyxia) Infant’s dietary intake
Physical examination Jitteriness
Seizures
Associated features (IDM, premature, birth asphyxia) Laboratory investigations
Serum Ca, Mg, P iCa, glucose Vitamin D metabolite
PTH Calcitonin Acid-base
ECG (Q-Tc > 0.4 sec or Q0-Tc > 0.2 sec) CXR (thymic shadow, aortic arch position) Urine drug screen
Other: malabsorption workup, maternal/family screening
Treatment
Low phosphate diet
Intravenous 10% Ca gluconate 2ml/kg IVD > 10min Nt : bradycardia, hypercalcemia, extravasation.
Oral 75-100 mg/k element calcium
50% MgSO4 0.05-0.1ml/k (0.1-0.2mmole/kg)
Oral 0.2ml/k (max 1.2ml/k in malabsorption syndrome)
Nt : oral type are not well-absorbed and large dosage. May cause diarrhea 1,25(OH)2D3 0.05-0.2ug/K/D
Common calcium preparations
prepration Elemental calcium content(mg)
Ca gluconate(10% inj) 9.0mg/ml
Ca Carbonate(500mg) 200mg/tab
Mineral contents of infant diets
Type of milk Ca(mg/l) P(mg/L)
Human milk 340 160
Similac Pm 60/40 380 190
SMA 425 290
Similac 510 390
Enfamil 470 320
Isomil 710 510
Prosobee 635 500
Similac special care 24 1460 730
Enfamil premature 24 1340 670
