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 < 4 mg/dl.
- Acidosis results in an increased ionizedcalcium and alkalosis decreases it.
Screening for hypocalcemia is indicated in:
1 . Preterm neonates.
2 . I.D.M.
3 . Severe perinatal asphyxia.
range from asymptomatic to jitteriness,
tremor of the extremities, tetany,
cardiac arrhythmias, convulsions, apnea
Types of Hypocalcemia:.Early: 1
within the first 72 hours due to poor feeding
e.g. in RDS, preterm, I.D.M., sepsis.
at 5 - 7 days up to several weeks due to
transient hypoparathyroidism or
high phosphorus in milk.
TREATMENT:If convulsions are present give 10 %
calcium gluconate 100 - 200 mg/kg by
i.v. infusion ( 0.2 - 0.5 ml/kg) for three days.
Always watch for extravasation & tissuingof calcium which may cause skin necrosis.
Oral vit.D 5000 I.U./day should also be given.