HYPOCALCEMIA:
Calcium is present in three forms:
1. Protein bound (40%).
2. Bound to citrate or phosphate (10%).
3. Ionized:the active part (50%).
Hypocalcemia is defined as serum
calcium < 2 mmol/L (8 mg/dL) in term or less
than 1.75 mmol/L (7 mg/dL) in preterm
neonates, or ionized calcium < 4mg/dl.
-Acidosis results in an increased ionized
calcium and alkalosis decreases it.
Screening for hypocalcemia is indicated in:
1. Preterm neonates.
2. I.D.M.
3. Severe perinatal asphyxia.
Clinical Features:
range from asymptomatic to jitteriness,
tremor of the extremities, tetany,
cardiac arrhythmias, convulsions, apnea
and stridor.
Types of Hypocalcemia:
.Early:
1
within the first 72 hours due to poor feeding
e.g. in RDS, preterm, I.D.M., sepsis.
.Late:
2
at 5-7days up to several weeks due to
transient hypoparathyroidism or
high phosphorus in milk.
TREATMENT:
If convulsions are present give 10%
calcium gluconate 100-200mg/kg by
i.v. infusion (0.2-0.5ml/kg) for three days.
Always watch for extravasation & tissuing
of calcium which may cause skin necrosis.
Oral vit.D 5000 I.U./day should also be given.
