Calcium in Newborn

7/25/2019 Calcium in Newborn

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Calcium innewborns

Dr. Bhushan


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Introduction

Calcium is most abundant mineral in the body and

together with phosphorus form a major inorganic

constituent of bone.

In circulation the amount of calcium and magnesium is

less 1% of their respective total body content.

Total body content of calcium and magnesium in skeletonare about 99% and !%respectively.


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Hormonal regulation"

#arathyroid$ renal hormonal ais"

#arathyroid hormone mobili&es calcium and phosphorus from

bone.

It stimulates calcium reabsorption and inhibits phosphorus

reabsorption by kidney.

'timulates (IT )* synthesis which help in intestinalabsorption of ca and phosphorus.

serum Ca rise and phosphorus level normal or decline.


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Hormonal regulation(Ctd)"

Calcitonin"

lower serum calcium and phosphorus chiefly by inhibiting

bone resorption.

It has an anti hypercalcemic effect.

it inhibits bone resorption.


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Hypocalcemia

serum ca level of less than +mg,dl.

Ioni&ed ca concentration of less than -mg,dl1mmol,l/.


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Clinical presentation"

'ign usually non specific.

0pnea

'ei&ure 2itteriness

3yperrefleia.

'tridor

4arly onset hypocalcemia" often asymptomatic but may showapnea or may show abnormalities of cardiac function.

5ate onset hypocalcemia" may present as hypocalcemia sei&ures.


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Diagnosis

Early onset hypocalcemia:

aboratory" total or ioni&ed serum calcium low.

4C6"prolonged 7T interval but clinically not useful in

newborn period.

ate onset hypocalcemia"

first line'erum phosphate

'erum alkaline phosphate

'econd line

'erum magnesium

'erum parathormone level

8rine calcium creatinine ratio

aternal calciumphosphatealkaline phosphatase


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Disorders causing hypocalcaemia

3ypoparathyroidism"

#hosphate" high

'erum alkaline phosphataseparathyroid hormonevitamin )" low.

#seudohypoparathyroidism"

'erum alkaline phosphataseparathyroidhormonephosphate"high

(itamin )" low.

Chronic renal failure"

#arathyroid hormonephosphateserum alkalinephosphatase"high

(itamin d" low

3ypomagnesemia"#arathyroid hormone "high

#hosphatemagnesium" low


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!symptomatic

+!mg,kg,day for -+ hours

+ml,kg,day of 1!%calcium gluconate/

Taper to -! mg,kg,day for one day then stop.


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"ymptomatic

:olus of ;ml,kg calcium gluconate 1"1 diluted with


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#anagement

If the ioni&ed ca level drop to !.+mmol,l therapy withcalcium alone is usually ade>uate but in some casesagnesium is also indicatedshould receive ; doses of!.;ml,kg/.

1! %calcium gluconate solution is preferred for I( use.

)ose of elemental ca is

#recaution"? rapid infusion of ca lead to brady arrythmias.

? Calcium should only be pushed for treatment ofhypocalcemia crisis and done with careful cardiac

monitoring.? Calcium should not be infuse throu h umbilical line.


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#anagement :

To prevent onset of hypocalcemia in severe stressed baby continuouscalcium infusion is used preferable by means of central catheter tomaintain an ioni&ed ca of 1 to1.< mmol,l

4mergency calcium therapyfor active sei&ure/consist of 1!! to ;!!mg,kg of 1!%calcium gluconate9$1+ mg of elemental ca,kg/by I( over 1

Calcium in Newborn

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