Upload
snehal-patil
View
218
Download
0
Embed Size (px)
Citation preview
7/25/2019 Calcium in Newborn
1/32
Calcium innewborns
Dr. Bhushan
7/25/2019 Calcium in Newborn
2/32
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.
7/25/2019 Calcium in Newborn
3/32
7/25/2019 Calcium in Newborn
4/32
7/25/2019 Calcium in Newborn
5/32
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.
7/25/2019 Calcium in Newborn
6/32
Hormonal regulation(Ctd)"
Calcitonin"
lower serum calcium and phosphorus chiefly by inhibiting
bone resorption.
It has an anti hypercalcemic effect.
it inhibits bone resorption.
7/25/2019 Calcium in Newborn
7/32
Hypocalcemia
serum ca level of less than +mg,dl.
Ioni&ed ca concentration of less than -mg,dl1mmol,l/.
7/25/2019 Calcium in Newborn
8/32
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.
7/25/2019 Calcium in Newborn
9/32
7/25/2019 Calcium in Newborn
10/32
7/25/2019 Calcium in Newborn
11/32
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
7/25/2019 Calcium in Newborn
12/32
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
7/25/2019 Calcium in Newborn
13/32
!symptomatic
+!mg,kg,day for -+ hours
+ml,kg,day of 1!%calcium gluconate/
Taper to -! mg,kg,day for one day then stop.
7/25/2019 Calcium in Newborn
14/32
"ymptomatic
:olus of ;ml,kg calcium gluconate 1"1 diluted with
7/25/2019 Calcium in Newborn
15/32
#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.
7/25/2019 Calcium in Newborn
16/32
#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