neonatal hypocalcemia & hypomagnesemia s – ghami md

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Neonatal Hypocalcemia & Hypomagnesemia S Ghami MD Slide 2 Hypocalcemia is a common metabolic problem in newborns. Hypocalcemia in full-term infants or preterm infants >1500 gr: Ca 2+ 4-sick or stressed infants, ca is measured at: 12-24 and 48 hour of age 5-if the infants does no respond to treatment: Mg, P, PTH, 25-hydroxy-VD levels, urinary ca, renal function, cxray, should be measured. b-In ECG Qt interval>0.4" Do not recommend use to screen for hypocalcemia. 4-sick or stressed infants, ca is measured at: 12-24 and 48 hour of age 5-if the infants does no respond to treatment: Mg, P, PTH, 25-hydroxy-VD levels, urinary ca, renal function, cxray, should be measured. b-In ECG Qt interval>0.4" Do not recommend use to screen for hypocalcemia. Slide 30 Management: I-treatment of early onset hypocalcemia: 1-Hypocalcemic preterm infants who have no symptoms and are well newborns donot require specific treatment, only initiating early feeling,if possible, because hypocalcemia resolve spontaneously by day 3. Management: I-treatment of early onset hypocalcemia: 1-Hypocalcemic preterm infants who have no symptoms and are well newborns donot require specific treatment, only initiating early feeling,if possible, because hypocalcemia resolve spontaneously by day 3. Slide 31 Slide 32 2- If the serum ca level c- If parenteral ca infusion is continued for more than 48h, additional P also must be provided. 3-prevent the onsot of hypocalcemia for newborns who are ill (eg.severe RDS, asphyxia, septice shock, PPHN,.) to maintain a total ca>7.0 mg/dl c- If parenteral ca infusion is continued for more than 48h, additional P also must be provided. 3-prevent the onsot of hypocalcemia for newborns who are ill (eg.severe RDS, asphyxia, septice shock, PPHN,.) to maintain a total ca>7.0 mg/dl Slide 34 II-treatmnt of symptomatic hypocalcemic infants, seizures, apnea, severe jitteriness,(serum ca level< 5.0 mg/dl): 1- treatment with 10% ca gluconate (100 mg/kg or 1cc/kg Iv or 9-18 mg of elemental ca/kg) by interavenous infusion over 5-10 minutes. II-treatmnt of symptomatic hypocalcemic infants, seizures, apnea, severe jitteriness,(serum ca level< 5.0 mg/dl): 1- treatment with 10% ca gluconate (100 mg/kg or 1cc/kg Iv or 9-18 mg of elemental ca/kg) by interavenous infusion over 5-10 minutes. Slide 35 a. monitor heart rate and the infusion site. b. repeat the dose in 10 minutes if there is no clinical response. c. after acute treatment, maintenance ca gluconate. Should be added to the intravenous solution. d. If enteral feeding are tolerated, ca gluconate 10% (500 /kg/duy) can be given in four six feedings. e. For late hypocalcemia as a consequence of the hyperparathyroidism (Digeorge syndrome) may require both ca and vitamin D (calcitriol) to maintain normocalcemia. a. monitor heart rate and the infusion site. b. repeat the dose in 10 minutes if there is no clinical response. c. after acute treatment, maintenance ca gluconate. Should be added to the intravenous solution. d. If enteral feeding are tolerated, ca gluconate 10% (500 /kg/duy) can be given in four six feedings. e. For late hypocalcemia as a consequence of the hyperparathyroidism (Digeorge syndrome) may require both ca and vitamin D (calcitriol) to maintain normocalcemia. Slide 36 Risks of calcium infusion: 1-Bradyarrhythmias rapid elevations in serum ca concentration. 2-extravasation into subcutaneous tissues necrosis and subcutaneous calcification. 3-Hepatic necrosis infusion through an umbilical venous catheter, if the tip is in a branch of portal vein. 4-Intestinal necrosis rapid infusion by umbilical artery and arterial spasms. Risks of calcium infusion: 1-Bradyarrhythmias rapid elevations in serum ca concentration. 2-extravasation into subcutaneous tissues necrosis and subcutaneous calcification. 3-Hepatic necrosis infusion through an umbilical venous catheter, if the tip is in a branch of portal vein. 4-Intestinal necrosis rapid infusion by umbilical artery and arterial spasms. result from Caused by result from Slide 37 2-symptomatic hypocalcemia unresponsive to ca therapy 1)Hypomagnesemia: therapy with 50% magnesium sulfate solution(500 mg or 4meg/ml) Dose:25-50mg/kg or 0.2-0.4 meq/kg/dose Iv or IM. 2-Hyperphosphatemia: Infant should be fed a diet high in calcium and low in phosphorus. Such as human milk or formula with low phosphorus, or oral ca supplements. 2-symptomatic hypocalcemia unresponsive to ca therapy 1)Hypomagnesemia: therapy with 50% magnesium sulfate solution(500 mg or 4meg/ml) Dose:25-50mg/kg or 0.2-0.4 meq/kg/dose Iv or IM. 2-Hyperphosphatemia: Infant should be fed a diet high in calcium and low in phosphorus. Such as human milk or formula with low phosphorus, or oral ca supplements. Slide 38 3- vitamin D deficiency Secondary to maternal vitamin D deficiency (anticonvulsant therapy). Treatment with 1000-2000 Iu /day of oral vitamin D +40 mg/kg/day of elemantal ca for 4 weeks. 3- vitamin D deficiency Secondary to maternal vitamin D deficiency (anticonvulsant therapy). Treatment with 1000-2000 Iu /day of oral vitamin D +40 mg/kg/day of elemantal ca for 4 weeks. Slide 39

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