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Neonate > Hypocalcaemia > Flashcards

Hypocalcaemia Flashcards

1
Q

When does the majority of fetal calcium accretion occur?

A

During the third trimester.

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2
Q

What happens to calcium levels within 24 hours after abrupt placental transfer?

A

They drop.

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3
Q

How long does it take for calcium levels to reach levels in older children after the drop?

A

Two weeks.

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4
Q

Why may the measurement of total calcium be misleading?

A

In states of low albumin.

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5
Q

What may happen to total calcium levels in states of low albumin despite normal ionized calcium?

A

Total calcium may be low.

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6
Q

What should be measured in states of hypocalcemia for accurate assessment?

A

Whole blood ionized calcium.

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7
Q

What are the criteria for hypocalcemia in newborns weighing more than 1500g?

A

Total calcium < 2 mmol/l,
Ionised calcium < 1.1 mmol/l.

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8
Q

What are the criteria for hypocalcemia in newborns weighing less than 1500g?

A

Total calcium < 1.75 mmol/l,
Ionised calcium < 0.9 mmol/l.

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9
Q

When are signs of hypocalcemia rare in newborns?

A

If ionized calcium > 0.8-0.9 mmol/l.

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10
Q

Signs of hypocalcaemia

A
  • Jitteriness.
  • Neuromuscular irritability.
  • High pitched cry.
  • Seizures.
  • Stridor/ wheezing.
  • Tetany.
  • Decreased mycocardial function.
    Some newborn infants may be asymptomatic.
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11
Q

When is hypocalcemia common in newborns?

A

Between 12 and 72 hours of life.

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12
Q

Which infants are especially prone to hypocalcemia during this time?

A

Preterm infants.

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13
Q

What may be a contributing factor to hypocalcemia during this period?

A

PTH immaturity.

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14
Q

After the initial period, what becomes the primary determinant of calcium levels?

A

Feeding.

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15
Q

When does early hypocalcemia occur?

A

In the first 2-3 days of life.

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16
Q

How is early hypocalcemia characterized in terms of normal physiological changes?

A

It is an exaggeration of a normal physiological drop.

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17
Q

Causes of early hypocalcemia

A
  1. Prematurity
    * 1/3 of preterm infants have low calcium levels.
  2. Infant of diabetic mothers (IDM)
  3. Perinatal hypoxia
  4. Di George syndrome
  5. Intrauterine growth restriction
  6. Maternal hyperparathyrodism
  7. Hypomagnesemia
  8. Hypoparathyrodism
  9. Maternal Vitamin D deficiency
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18
Q

Di George syndrome

A
  • Hypoplastic parathyroid glands.
  • 1 in 4000 newborn infants.
  • 90%: deletion of 22 q.
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19
Q

When does late hypocalcemia occur

A

Occurs at the end of the first week

20
Q

Causes of late hypocalcemia

A
  1. Vitamin D deficiency
  2. High phosphate intake
  3. Transfusion with citrated blood
  4. Lipid infusions (TPN)
  5. Acute renal failure
    * High phosphate
21
Q

High phosphate intake

A
  • Associated with cows milk/cows milk formula.
  • Suppresses/antagonises PTH.
22
Q

effects of High phosphate intake

A

Acute renal failure

23
Q

In which scenarios should calcium, magnesium, and phosphate be monitored?

A

In certain high-risk scenarios.

24
Q

When should measurement of calcium be considered in newborns?
Answer:

A

i. Infants with congenital cardiac lesions, especially outflow tract lesions where there is a concern of Di George Syndrome.
ii. Infants showing signs consistent with hypocalcemia.
iii. Infants with hypoxic-ischemic encephalopathy (HIE) being cooled.

25
Q

When might further investigations be necessary for hypocalcemic newborns?

A

i. If severely symptomatic (e.g., fitting).
ii. If early hypocalcemia persists despite treatment.
iii. In situations of late hypocalcemia.

26
Q

When should treatment be initiated for hypocalcemic newborns?

A

For symptomatic newborn infants or those with total serum calcium levels < 1.8 mmol or ionised calcium levels < 0.9 mmol/l.

27
Q

What is the treatment for hypocalcemia in newborns?

A

Intravenous administration of 10% calcium gluconate, given slowly to avoid bradycardia/asystole.

28
Q

How should the dose of calcium gluconate be administered?

A

It may be repeated as needed, and maintenance calcium therapy may be initiated.

29
Q

What should be done if neonatal hypocalcemia persists and prolongs?

A

Investigate for the underlying cause.

30
Q

What is the serum magnesium level indicative of hypomagnesemia?

A

Serum magnesium < 0.65 mmol/l.

31
Q

Is hypomagnesemia usually found as a standalone condition?

A

No, it’s unusual on its own.

32
Q

With what condition is hypomagnesemia commonly associated?

A

Persistent hypocalcemia.

33
Q

In which population is hypomagnesemia most commonly seen along with associated hypocalcemia?

A

Infants of diabetic mothers (IDMs).

34
Q

Besides IDMs, what other conditions might be associated with hypomagnesemia?

A

Rare disorders of intestinal/renal tubular magnesium transport.

35
Q

How is hypomagnesemia treated?

A

Intramuscular or slow intravenous administration of magnesium sulfate (MgSO4). Treatment is only required if symptomatic.

36
Q

Definition of hyponatreamia

A

Serum sodium < 130mmol/l

37
Q

Common causes o hyponatreamia

A
  1. Prematurity.
  2. Inadequate sodium intake.
  3. Excessive fluid intake.
  4. Diuretics.
  5. Renal impairment.
  6. Gastric losses.
  7. SIADH.
  8. Congenital adrenal hyperplasia
38
Q

What should be considered if there is weight gain or absence of weight loss along with hyponatremia?

A
  • Consider dilutional causes from fluid overload or CCF or SIADH.
  • Establish and treat the underlying cause.
  • Restrict total fluid intake.
39
Q

What steps should be taken if there is weight loss along with hyponatremia?

A
  • Consider sodium losses from osmotic diuresis, diuretics, GIT or renal losses.
  • Establish the cause.
  • Supplement sodium either orally or intravenously.
  • Replace losses and deficit.
40
Q

How should symptomatic hyponatremia or serum sodium < 120mmol/l be managed?

A

Replace over 24 hours with hypertonic saline after correcting for sodium deficit. However, caution should be exercised to avoid correcting too quickly due to the risk of pontine demyelination.

41
Q

What is the serum sodium level indicative of hypernatremia?

A

Serum sodium > 145 mmol/l.

42
Q

What conditions are hypernatremia associated with?

A

Cerebral venous thrombosis and intracerebral bleeds.

43
Q

Common causes of hypernatremia

A
  1. Excessive water loss.
  2. Insensible losses from the skin.
  3. Gastric losses.
  4. Polyuria.
  5. Excessive sodium intake.
44
Q

What initial steps should be taken in the management of hypernatremia?

A

Review for dehydration, assess sources of fluid loss, and evaluate sodium-containing infusions or medications.

45
Q

What should be considered if there is weight loss along with hypernatremia?

A

a. Determine if there is water loss.
b. Increase fluid intake or reduce sodium intake appropriately.
c. Reduce insensible losses.

46
Q

What is the next step in managing hypernatremia?

A

Establish the underlying cause.

47
Q

How should chronic hypernatremia be corrected?

A

Over 24 hours. Avoid correcting too quickly to prevent the risk of cerebral edema.

Neonate (34 decks)

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