scholarly journals Clinical Approach to Hypocalcemia in Newborn Period and Infancy: Who Should Be Treated?

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Dogus Vuralli
Keyword(s):  
Preterm Infants ◽  
Serum Calcium ◽  
Gestational Age ◽  
Late Onset ◽  
Ionized Calcium ◽  
Total Serum ◽  
Specific Reference ◽  
Clinical Approach ◽  
Newborn Period ◽  
Total Serum Calcium

Introduction. Hypocalcemia is a common metabolic problem in newborn period and infancy. There is consensus on the treatment of the symptomatic cases while the calcium level at which the treatment will be initiated and the treatment options are still controversial in asymptomatic hypocalcemia. Methods. This review article will cover hypocalcemia with specific reference to calcium homeostasis and definition, etiology, diagnosis, and treatment of hypocalcemia in newborn and infancy period. Results. Hypocalcemia is defined as total serum calcium <8 mg/dL (2 mmol/L) or ionized calcium <4.4 mg/dL (1.1 mmol/L) for term infants or preterm infants weighing >1500 g at birth and total serum calcium <7 mg/dL (1.75 mmol/L) or ionized calcium <4 mg/dL (1 mmol/L) for very low birth weight infants weighing <1500 g. Early-onset hypocalcemia is generally asymptomatic; therefore, screening for hypocalcemia at the 24th and 48th hour after birth is warranted for infants with high risk of developing hypocalcemia. Late-onset hypocalcemia, which is generally symptomatic, develops after the first 72 h and toward the end of the first week of life. Excessive phosphate intake, hypomagnesemia, hypoparathyroidism, and vitamin D deficiency are commonest causes of late-onset hypocalcemia. Hypocalcemia should be treated according to etiology. Calcium replacement is the cornerstone of the treatment. Elementary calcium replacement of 40 to 80 mg/kg/d is recommended for asymptomatic newborns. Elementary calcium of 10 to 20 mg/kg (1–2 mL/kg/dose 10% calcium gluconate) is given as a slow intravenous infusion in the acute treatment of hypocalcemia in patients with symptoms of tetany or hypocalcemic convulsion. Conclusion. Since most infants with hypocalcemia are usually asymptomatic, serum total or ionized calcium levels must be monitored in preterm infants with a gestational age <32 weeks, small for gestational age infants, infants of diabetic mothers, and infants with severe prenatal asphyxia with a 1 min Apgar score of <4. The treatment of hypocalcemia should be initiated immediately in infants with reduced calcium levels while investigating the etiology.

scholarly journals Association of dietary calcium intake, total and ionized serum calcium levels with preeclampsia in Ethiopia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rahel D. Gebreyohannes ◽  
Ahmed Abdella ◽  
Wondimu Ayele ◽  
Ahizechukwu C. Eke
Keyword(s):  
Serum Calcium ◽  
Calcium Intake ◽  
Calcium Level ◽  
Serum Calcium Level ◽  
Dietary Calcium ◽  
Ionized Calcium ◽  
Dietary Calcium Intake ◽  
Total Serum ◽  
Total Serum Calcium ◽  
Total Serum Calcium Level

Abstract Background Preeclampsia is a well-known cause of maternal mortality and morbidity in Ethiopia. The exact pathophysiology has not been fully understood. Calcium and magnesium deficiencies have been given emphasis to play roles in the pathophysiology. Although evidence is abundant, they are equivocal. The study aimed to see the association of dietary calcium intake, serum total calcium level and ionized calcium level with preeclampsia. It also evaluated the association between dietary calcium intake and serum calcium levels. Materials and methods An unmatched case–control study was conducted in Gandhi Memorial, Tikur Anbessa, and Zewditu Memorial Hospitals, all in Addis Ababa, between October to December, 2019. Cases were 42 women with preeclampsia and controls were 42 normotensive women. The medical and obstetric history was gathered using a structured questionnaire and the dietary calcium intake information using a 24-h dietary recall. The serum levels of total serum calcium and ionized (free) calcium were measured using an inductively coupled mass spectrophotometer. Bivariate and multivariate logistic regression and Pearson correlation test were utilized during data analysis. Results In comparison with controls, women with preeclampsia had lower mean (± 1SD) levels of ionized calcium level (1.1 mmol/l ± 0.11), total serum calcium level (1.99 mmol/l ± 0.35) and lower median (IQR) dietary calcium intake (704 mg/24 h,458–1183). The odds of having preeclampsia was almost eight times greater in those participants with low serum ionized calcium level (OR 7.5, 95% CI 2.388–23.608) and three times higher in those with low total serum calcium level (OR 3.0, 95% CI 1.024–9.370). Low dietary calcium intake also showed statistically significant association with preeclampsia (OR 3.4, 95% CI 1.092 -10.723). Serum ionized calcium level and total serum calcium level showed positive correlation of moderate strength (p = 0.004, r = 0.307), but no correlation was found between dietary calcium intake with both forms of serum calcium levels. Conclusion This study showed significant association between low dietary calcium intake and low serum calcium levels with preeclampsia, hence this can be used as a supportive local evidence for the current context-specific recommendation of calcium supplementation in societies with low-dietary calcium consumption in an attempt to prevent preeclampsia, therefore implementation study should be considered in Ethiopia to look for the feasibility of routine supplementation.

Late Onset Hypocalcemic Seizures in Formula-Fed, Vitamin D Deficient Babies: Revisited

2020 ◽  
Vol 34 (1-2) ◽  
pp. 15-18
Author(s):  
Umar Amin Qureshi ◽  
Abdus Sami Bhat ◽  
Muzaffar Jan ◽  
Uruj Qureshi
Keyword(s):  
Vitamin D ◽  
Breast Feeding ◽  
Serum Calcium ◽  
Late Onset ◽  
Response To Treatment ◽  
Total Serum ◽  
Total Serum Calcium ◽  
Vitamin D Levels ◽  
Calcium Phosphorus ◽  
25 Oh Vitamin D

Purpose: Late onset neonatal hypocalcemia (LNH) is defined as hypocalcemia detected after day 3 of life. Its occurrence in babies fed with cow’s milk is well understood. Since the advent of modern-day formulas, the incidence has however decreased. Methods: A prospective descriptive study (January 2017 to December 2017) of LNH seizures in neonates was conducted. LNH was defined as the total serum calcium of less than 7 mg/dL in preterm or less than 8 mg/dL in term newborns after 72 h of life. Results: 14 neonates were presented with myoclonic and focal seizures due to late hypocalcemia. All were formula fed. Their mean serum calcium, phosphorus, alkaline phosphatase, magnesium, 25-OH vitamin D, intact PTH levels were 4.93 mg/dL, 9.19 mg/dL, 244 U/L, 1.2 mg/dL, 30 nmol/L, 38.6 pg/mL, respectively. Mean maternal vitamin D levels were 43 nmol/L. Mean hospital stay was 4 days. Clinical response to treatment was brisk in those who were able to shift to total breast feeding early. Conclusions: LNH in formula-fed and vitamin D deficient babies is not uncommon. Emphasis should be laid on exclusive breast feeding even in vitamin D deplete mothers. However, mothers at risk should be supplemented with vitamin D during pregnancy.

Optimal Discrimination of Mild Hyperparathyroidism with Total Serum Calcium, Ionized Calcium and Parathyroid Hormone Measurements

1987 ◽  
Vol 92 (2) ◽  
pp. 147-176 ◽  
Author(s):  
Lars Benson ◽  
Sverker Ljunghall ◽  
Torgny Groth ◽  
Hans Falk ◽  
Andreas Hvarfner ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Serum Calcium ◽  
Ionized Calcium ◽  
Total Serum ◽  
Total Serum Calcium

scholarly journals COMPARISON OF SERUM CALCIUM LEVELS AMONG EXTREMELY PRETERM AND SEVERLY PRETERM NEONATES AT A PERIPHERAL MILITARY HOSPITAL

2021 ◽  
Vol 71 (4) ◽  
pp. 1292-95
Author(s):  
Sohail Aslam ◽  
Fawad Ahmad Khan ◽  
Omer Tufail ◽  
Naila Mumtaz ◽  
Syed Uzair Maqsood ◽  
...  
Keyword(s):  
Serum Calcium ◽  
Gestational Age ◽  
Venous Blood ◽  
Military Hospital ◽  
Preterm Neonates ◽  
Total Serum ◽  
Cross Sectional ◽  
Very Preterm ◽  
Total Serum Calcium ◽  
Extremely Preterm

Objective: To determine the frequency and compare serum calcium levels amongst extremely preterm and very preterm neonates. Study Design: Comparative cross sectional study. Place and Duration of Study: Combined Military Hospital, Multan Pakistan, from May to Oct 2018. Methodology: A total of 217 preterm neonates, born at Combined Military Hospital Multan up to the gestational age of 32 weeks completed from last menstrual period, were included in the study. They were divided in to two group’s i.e. very preterm and extremely preterm neonates. Those born between 28-32 weeks completed of gestation were categorized as severely preterm. Extremely preterm were those born between 24-28 weeks completed of gestation. Venous blood samples were acquired at approximately 36 hours after birth and total serum calcium levels were analyzed. Neonates having total serum calcium levels <7 mg/dL were declared as suffering from hypocalcaemia. Results: Out of 217 neonates, 117 (53.9%) were male while 100 (46.1%) were female. Mean gestational age was 30.98 ± 2.12 weeks while mean parity of the mothers was 2.82 ± 1.08 children. Mean birth weight was 1510.26 ± 142.38 grams. One hundred and seventeen (53.9%) of the preterm neonates suffered from hypocalcaemia with the mean total serum calcium level being 6.58 ± 0.86 mg/dL. Hypocalcaemia was more common in extremely preterm neonates compared to very preterm neonates (p<0.05). Conclusion: Hypocalcaemia is a frequent complication encountered in preterm neonates born between 24-32 weeks gestation. Within these neonates, the frequency of hypocalcaemia is higher in extremely preterm compared to severely preterm babies.

Ionized Calcium, Cardiac Function, and Electrocardiogram in Preterm Neonates

PEDIATRICS ◽  
1986 ◽  
Vol 78 (3) ◽  
pp. 541-542
Author(s):  
JENS MÖLLER ◽  
F. K. TEGTMEYER
Keyword(s):  
Cardiac Function ◽  
Causal Relationship ◽  
Serum Calcium ◽  
Cardiac Failure ◽  
Calcium Level ◽  
Ionized Calcium ◽  
Preterm Neonates ◽  
Total Serum ◽  
Total Serum Calcium

To the Editor.— We would like to add some comments on the article by Venkataraman et al.1 In one respect it might be quite dangerous not to measure the ionized calcium in preterm neonates. If you find prolongation of QTc or QoTc intervals in the ECG during cardiac failure in these infants and find subnormal total serum calcium levels, you might make a wrong conclusion on causal relationship. Until now, we have seen five preterm neonates with OTc/QoTc prolongation and profound low total serum calcium levels, whereas the measured ionized calcium level was normal.

Serum ionized calcium and corrected total calcium in borderline hyperparathyroidism.

1978 ◽  
Vol 24 (11) ◽  
pp. 1962-1965 ◽  
Author(s):  
L Larsson ◽  
S Ohman
Keyword(s):  
Serum Calcium ◽  
Reference Range ◽  
Reference Group ◽  
Ionized Calcium ◽  
Total Serum ◽  
Albumin Concentration ◽  
Serum Calcium Concentration ◽  
Normal Limits ◽  
Total Serum Calcium ◽  
Serum Ionized Calcium

Abstract We studied 25 borderline-hyperparathyroidism patients whose total serum calcium concentration was within normal limits (reference range: 2.25--2.75 mmol/liter) but whose concentrations of serum ionized calcium were above normal (reference range: 1.03--1.23 mmol/liter). Their hyperparathyroidism was histopathologically verified. To compare the discriminating value of corrected serum calcium with ionized calcium, we studied the serum calcium and albumin concentrations in a reference group of 2098 patients. After patients from endocrine and dialysis departments were excluded from the reference group, we obtained the range (mean +/- 2 SD) 2.05--2.71 mmol/liter for uncorrected serum calcium and 2.11--2.63 mmol/liter for corrected serum calcium. The correction factor for calcium on albumin was 20 mumol/g. Even with this limit for corrected serum calcium, 13 of 25 borderline hyperparathyroidism patients had values that fell within the reference range. We conclude that correcting total serum calcium values for serum albumin concentration improves discrimination of borderline hyperparathyroid patients, but that measurement of ionized calcium in serum discriminates better.

scholarly journals Non-corrected total serum calcium sufficiently reflects ionized calcium level.

2002 ◽  
Vol 35 (12) ◽  
pp. 1523-1525
Author(s):  
Naganori Sato ◽  
Yoshitaka Maeda ◽  
Tatsuo Shiigai
Keyword(s):  
Serum Calcium ◽  
Calcium Level ◽  
Ionized Calcium ◽  
Total Serum ◽  
Total Serum Calcium

scholarly journals SUN-LB67 Revisit Serum Calcium Correction

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Yulong Li ◽  
JunJia Zhu ◽  
Jenny Blau ◽  
William F Simonds
Keyword(s):  
Serum Calcium ◽  
Repeated Measures ◽  
Calcium Level ◽  
Ionized Calcium ◽  
Total Serum ◽  
P Value ◽  
Total Calcium ◽  
Total Serum Calcium ◽  
Parathyroid Disease ◽  
Calcium Status

Abstract Context: The serum calcium level is one of most routinely ordered tests in clinical practice. Many factors can affect calcium level and its interpretation. There are challenges and barriers in applying calcium correction formulas to every-day practice. Objective: Revisit correlation between total and ionized calcium levels, and dependence of serum calcium on albumin, pH and creatinine levels. Methods: This study included 1537 subjects enrolled in a parathyroid disease clinical protocol. We examined calcium and relevant biochemistry tests collected simultaneously and repetitively over consecutive years. Histograms, repeated measures correlation, correlation plots, and liner regression plots were used to analyze and visualize the data. Results: We found that: 1) directly measured total serum calcium and ionized calcium had excellent correlation and dependence with p-value=2.2e-16, repeated measures correlation coefficient (rmcorr)=0.919, and 95% interval (CI) = 0.916 to 0.922; 2) there was a low dependence between total serum calcium and albumin levels (rmcorr=0.454, 95% CI=0.433 to 0.474), a low dependence between ionized calcium and pH levels (rmcorr=-0.309, 95% CI= -0.326 to -0.292), and no dependence between total calcium and creatinine levels (rmcorr=0.026 95% CI=0.012 to 0.040); 3) using the commonly applied correction formulas, to either adjust total calcium based on albumin levels or else adjust ionized calcium based on pH levels, did not improve dependence among them. Conclusions: We therefore suggest using directly measured total serum calcium and/or ionized calcium level to assess clinical calcium status in general patients tested for parathyroid related disorders.

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