Hypocalcemia

Causes

A healthy baby's body usually has very careful control of blood calcium levels. There are common causes of hypocalcemia in the sick newborn, including prematurity, stress, infection, maternal diabetes, and some medications. There are some rare illnesses that can result in low calcium levels. But some common causes are probably the most clinically relevant hypocalcemic emergencies in the ED and include the following:

• Rhabdomyolysis: Increased phosphates from creatine phosphokinase and other anions chelate calcium.
• Sepsis can cause hypocalcemia through many mechanisms.
• High calcitonin levels cause low calcium.
• Acute pancreatitis: Free fatty acids chelate calcium, causing saponification in the retroperitoneum.
• Toxic shock syndrome can cause hypocalcemia.

Symptoms

• Anorexia
• Nausea and vomiting
• Fatigue
• Paresthesias (especially perioral)
• Muscle twitching
• Generalized weakness

Signs

• Tremor
• Muscular twitching
• Chvostek's sign: tapping over the facial nerve causes twitching of the mouth
• Trousseau's sign: carpal spasm induced by inflating the blood pressure cuff between the systolic and diastolic pressures and leaving it inflated for 3 minutes
• Tetany and hyperreflexia
• Altered mentation: delirium and hallucinations
• Seizures are usually generalized and may be recurrent or refractory.

Treatment

Specific treatment for hypocalcemia will be determined by your baby's physician based on. Your baby's gestational age, overall health, and medical history, extent of the disease. Your baby's tolerance for specific medications, procedures, or therapies. Expectations for the course of the disease.

Hypocalaemia treatment may include:

• Supplemental calcium gluconate given by mouth
• Intravenous calcium gluconate
• Acute hypocalcemia

• Promptly correct symptomatic or tetany with parenteral administration of calcium salts.
• Measure serum calcium every 4-6 hours to maintain serum calcium levels at 8-9 mg/dL.
• Patients on digoxin therapy need continuous ECG monitoring during calcium replacement because calcium potentiates digitalis toxicity.
• Dietary calcium is an important part of the treatment of chronic hypocalcemia, particularly in the case of vitamin D deficiency.