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Pediatric Hypocalcemia Medication

  • Author: Yogangi Malhotra, MD; Chief Editor: Stephen Kemp, MD, PhD  more...
 
Updated: Nov 18, 2014
 

Medication Summary

Calcium therapy is the mainstay of treatment for hypocalcemia. Therapy with IV calcium is the most effective and rapid means of elevating serum calcium concentration. After hypocalcemia is controlled, follow-up treatment with oral therapy can be given. However, in patients with asymptomatic hypocalcemia, therapy with oral calcium alone may be sufficient.

Vitamin D, in one of its various forms, is also indicated, depending on the metabolic abnormality present. However, the use of vitamin D formulations in newborns to prevent hypocalcemia has not been effective. The most important aspect of management is resolution of the primary cause (e.g., hyperphosphatemia, hypomagnesemia).

The American Academy of Pediatrics (AAP) published revisions to guidelines for adequate vitamin D intake in infants, children, and adolescents.[13] The revised guidelines now recommend a minimum daily intake of 400 IU of vitamin D beginning in the first few days following birth and continuing through adolescence. Symptomatic hypocalcemia may occur during periods of rapid growth with increased metabolic demands, long before any physical findings or radiologic evidence of vitamin D deficiency occurs.

Although not used routinely due to the suggested risk of osteosarcoma, the administration of recombinant PTH in an infant with hypocalcemia refractory to calcitriol and calcium supplementation was reported to be effective.[14]

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Calcium compounds

Class Summary

Calcium is the most abundant mineral in the human body. It is essential for blood coagulation and the development and/or function of bone, teeth, nerves, and muscles. Calcium also functions as an enzymatic cofactor and affects endocrine secretory function. Supplements are used to increase serum calcium concentrations in patients with hypocalcemia. Oral preparations are prescribed to reduce phosphate absorption from the intestine in patients with hyperphosphatemia.

Calcium Gluconate and Calcium Chloride infusions

 

Calcium gluconate 10% (100 mg/mL) IV solution contains 9.8 mg/mL (0.45 mEq/mL) elemental calcium; calcium chloride 10% (100 mg/mL) contains 27 mg/mL (1.4 mEq/mL) elemental calcium.

Calcium chloride is more irritating to the veins and may affect pH; therefore, it is typically avoided in pediatric patients.

Calcium gluconate can also be given orally. However, it is hypertonic and may potentially increase risk of necrotizing enterocolitis in preterm infants at risk for this condition.

Calcium glubionate (Calcionate)

 

This is an oral calcium supplement. It is available as a liquid product containing glubionate salt (1800 mg/5 mL) and elemental calcium (115 mg /5 mL).

Calcium carbonate (Oyster Cal, Caltrate, Tums, Oysco 500)

 

Calcium carbonate is an oral supplement. In many ways, it is the calcium supplement of choice, because it provides 40% elemental calcium. (Therefore, 1 g of calcium carbonate provides 400 mg of elemental calcium.) It is well absorbed orally and is unlikely to cause diarrhea. Calcium carbonate is available in tablet and liquid form.

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Vitamin D metabolites

Class Summary

The active forms of vitamin D regulate calcium absorption and its uses in the body. They increase calcium levels by promoting absorption of calcium in the intestines and retention of it in the kidneys.

Calcitriol (Calcijex, Rocaltrol, Vectical)

 

This is an active metabolic form of vitamin D (i.e., 1,25-dihydroxycholecalciferol). It is especially useful in liver or renal impairment because these cause an inability to hydroxylate vitamin D to its active forms. Generally, the product is rapid-acting, but it may act slowly in neonates (36-48 h). Preterm infants may be resistant to calcitriol's actions. Calcitriol is also used to treat acute hypocalcemia.

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Contributor Information and Disclosures
Author

Yogangi Malhotra, MD Assistant Professor, Department of Pediatrics, Division of Neonatology, Albert Einstein College of Medicine; Attending Neonatologist, Montefiore New Rochelle Hospital

Yogangi Malhotra, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, New York State Perinatal Association

Disclosure: Nothing to disclose.

Coauthor(s)

Deborah E Campbell, MD, FAAP Professor of Clinical Pediatrics, Albert Einstein College of Medicine; Director, Department of Pediatrics, Division of Neonatology, Children's Hospital at Montefiore

Deborah E Campbell, MD, FAAP is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, American Pediatric Society, American Medical Association, National Perinatal Association, New York Academy of Medicine

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kemp, MD, PhD Former Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas for Medical Sciences College of Medicine, Arkansas Children's Hospital

Stephen Kemp, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Pediatric Society, Endocrine Society, Phi Beta Kappa, Southern Medical Association, Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Acknowledgements

George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London) Professor and Chair, First Department of Pediatrics, Athens University Medical School, Aghia Sophia Children's Hospital, Greece; UNESCO Chair on Adolescent Health Care, University of Athens, Greece

George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London) is a member of the following medical societies: American Academy of Pediatrics, American College of Endocrinology, American College of Physicians, American Pediatric Society, American Society for Clinical Investigation, Association of American Physicians, Endocrine Society, Pediatric Endocrine Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Robert J Ferry Jr, MD Le Bonheur Chair of Excellence in Endocrinology, Professor and Chief, Division of Pediatric Endocrinology and Metabolism, Department of Pediatrics, University of Tennessee Health Science Center

Robert J Ferry Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Diabetes Association, American Medical Association, Endocrine Society, Pediatric Endocrine Society, Society for Pediatric Research, and Texas Pediatric Society

Disclosure: Eli Lilly & Co Grant/research funds Investigator; MacroGenics, Inc Grant/research funds Investigator; Ipsen, SA (formerly Tercica, Inc) Grant/research funds Investigator; NovoNordisk SA Grant/research funds Investigator; Diamyd Grant/research funds Investigator; Bristol-Myers-Squibb Grant/research funds Other; Amylin Other; Pfizer Grant/research funds Other; Takeda Grant/research funds Other

Abhay Singhal, MD Assistant Professor of Clinical Pediatrics, Department of Pediatrics, Division of Neonatology, Indiana University School of Medicine

Abhay Singhal, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Sunil Sinha, MD Assistant Professor, Division of Pediatric Endocrinology and Metabolism, Department of Pediatrics, University of Tennessee Health Science Center

Sunil Sinha, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, Endocrine Society, and Pediatric Endocrine Society

Disclosure: Nothing to disclose.

Thomas A Wilson, MD Professor of Clinical Pediatrics, Chief and Program Director, Division of Pediatric Endocrinology, Department of Pediatrics, The School of Medicine at Stony Brook University Medical Center

Thomas A Wilson, MD is a member of the following medical societies: Endocrine Society, Pediatric Endocrine Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References
  1. Gertner JM. Disorders of calcium and phosphorus homeostasis. Pediatr Clin North Am. 1990 Dec. 37(6):1441-65. [Medline].

  2. Rubin LP. Disorders of calcium and phosphorus metabolism. Avery’s diseases of the Newborn. 9th edition. Philadelphia: WB Saunders; 1998.

  3. Tsang RC, Chen I, Hayes W, Atkinson W, Atherton H, Edwards N. Neonatal hypocalcemia in infants with birth asphyxia. J Pediatr. 1974 Mar. 84(3):428-33. [Medline].

  4. Venkataraman PS, Tsang RC, Chen IW, Sperling MA. Pathogenesis of early neonatal hypocalcemia: studies of serum calcitonin, gastrin, and plasma glucagon. J Pediatr. 1987 Apr. 110(4):599-603. [Medline].

  5. Venkataraman PS, Tsang RC, Greer FR, Noguchi A, Laskarzewski P, Steichen JJ. Late infantile tetany and secondary hyperparathyroidism in infants fed humanized cow milk formula. Longitudinal follow-up. Am J Dis Child. 1985 Jul. 139(7):664-8. [Medline].

  6. Thomas TC, Smith JM, White PC, Adhikari S. Transient neonatal hypocalcemia: presentation and outcomes. Pediatrics. 2012 Jun. 129(6):e1461-7. [Medline].

  7. Jackson GL, Sendelbach DM, Stehel EK, et al. Association of hypocalcemia with a change in gentamicin administration in neonates. Pediatr Nephrol. 2003 Jul. 18(7):653-6. [Medline].

  8. Alizadeh-Taheri P, Sajjadian N, Eivazzadeh B. Prevalence of phototherapy induced hypocalcemia in term neonate. Iran J Pediatr. 2013 Dec. 23(6):710-1. [Medline]. [Full Text].

  9. Venkataraman PS, Tsang RC, Steichen JJ, Grey I, Neylan M, Fleischman AR. Early neonatal hypocalcemia in extremely preterm infants. High incidence, early onset, and refractoriness to supraphysiologic doses of calcitriol. Am J Dis Child. 1986 Oct. 140(10):1004-8. [Medline].

  10. Thomas TC, Smith JM, White PC, Adhikari S. Transient neonatal hypocalcemia: presentation and outcomes. Pediatrics. 2012 Jun. 129(6):e1461-7. [Medline].

  11. Broner CW, Stidham GL, Westenkirchner DF, Tolley EA. Hypermagnesemia and hypocalcemia as predictors of high mortality in critically ill pediatric patients. Crit Care Med. 1990 Sep. 18(9):921-8. [Medline].

  12. Mulligan ML, Felton SK, Riek AE, Bernal-Mizrachi C. Implications of vitamin D deficiency in pregnancy and lactation. Am J Obstet Gynecol. 2009 Oct 19. [Medline].

  13. [Guideline] Wagner CL, Greer FR. Prevention of rickets and vitamin d deficiency in infants, children, and adolescents. Pediatrics. 2008 Nov. 122(5):1142-52. [Medline].

  14. Newfield RS. Recombinant PTH for initial management of neonatal hypocalcemia. N Engl J Med. 2007 Apr 19. 356(16):1687-8. [Medline].

 
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Electrocardiogram (ECG) findings in severe hypocalcemia.
 
 
 
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