| ID | 370 |
|---|---|
| Name | HYPOCALCEMIA |
| Cause | Poor nutrition for the mother during pregnancy. Making too much insulin because the mother has poorly controlled diabetes. Incompatible blood types of mother and baby (severe hemolytic disease of the newborn) |
| Signs Symptoms | Sweating. Feeding difficulties, poor suck. Weak or high-pitched cry. Tremors. Hypothermia. Irritability. Lethargy/stupor. Hypotonia. |
| Diagnosis | The physiological serum glucose values in healthy newborns range between 3.3 and 5 mmol/L. Neonatal hypoglycemia should be defined as serum glucose less than 2.2 mmol/L in the first 72 h of life and less than 2.5 mmol/L thereafter |
| Investigations | Investigations: Include- i. Serum calcium, ii. Phosphorus, iii. Alkaline phosphatase, iv. Mg & v. E.C.G |
| Management | Management: A. For asymptomatic hypocalcemia (Ca <1.75mmol/l or <7.0mg/dl without symptoms): 1. Calcium gluconate 10%, 5ml/kg/day oral or continuous i.v infusion. Oral dose is mixed with the total day’s feeding, the i.v dose is given by continuous infusion over 24 hours. After hypocalcemia is corrected, the dose can be gradually decreased over 48 hours. (Calcium gluconate 10% = 9.0mg of elemental Ca/ml). B. Acute symptomatic hypocalcemia with seizure, apnea or tetany (Calcium level usually <1.25mmol/l or <5.0mg/dl): 1. Emergency calcium therapy- Calcium gluconate 10%, liter/kg by i.v infusion over 10 minutes. Monitor heart rate. If decrease in heart rate, slowing or discontinuation of i.v infusion should be done. 2. Repeat the dose in 10 minutes if there is no clinical response. 3. Maintenance calcium should follow emergency therapy, oral or, i.v infusion 5ml/kg/day given over 24 hours period. 4. Vitamin D should be given orally 500 i.u/day. C. Unresponsiveness to treatment: 1. Treatment is rarely unresponsive, or necessary for more than 5 days unless complicated e.g associated hypomagnesemia. Correct hypomagnesemia with 0.2ml/kg/dose of magnesium sulphate 50% by i.m injection. 2. The dose may be repeated every 6-12 hours for further 1 to 2 times. |
| Introduction | Hypocalcemia: A low serum calcium level <1.75mmol/l (or <7.0mg/dl) is design-ated as hypocalcemic, usually found in the first few days of life in small preterm, the “ill” babies & infants of diabetic mothers, specially if they are on i.v drips. May follow after exchange transfusion. Symptoms are rarely developed. Presenting feature: Tremulousness, tetany, irritability, cyanosis, apnoea, feeds well, alert & normally active. Vomiting, hypertonicity, convulsion, laryngospasm, carpopedal spasm, Chvostek’s sign are present less frequently. |
| History | |
| Etiology | see under causes |
| Clinical Features | see under sign and symptoms |
| Preventions | Delay the first bath |
| Treatment | |
| Complications | Long-term neurodevelopmental disabilities, cerebral palsy, and death |
| Prognosis | |
| Types | Neonatal hypoglycemia, defined as a plasma glucose level of less than 30 mg/dL (1.65 mmol/L) in the first 24 hours of life and less than 45 mg/dL (2.5 mmol/L) thereafter, is the most common metabolic problem in newborns |
| Classification | |
| Observation | |
| Pathology |
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