Pediatric Hypocalcemia Treatment & Management
- Author: Robert J Ferry Jr, MD; Chief Editor: Stephen Kemp, MD, PhD more...
Approach Considerations
Any newborn infant with hypocalcemia should be monitored in the neonatal ICU. (Because most babies with hypocalcemia are preterm, they often have already been admitted there.)
Treatment of asymptomatic patients with hypocalcemia remains controversial, especially with regard to neonates. Some authorities suggest that treating such patients is unnecessary. Most clinicians agree, however, that hypocalcemia should be treated promptly in any symptomatic neonate or older child because of the condition’s serious implications for neuronal and cardiac function. Any child with symptomatic hypocalcemia should be admitted to the hospital unless the diagnosis is hyperventilation.
Oral calcium therapy is used in asymptomatic patients and as follow-up to intravenous (IV) calcium therapy. IV treatment is usually indicated in patients having seizures, those who are critically ill, and those who are planning to have surgery.
However, IV infusion with calcium-containing solutions can cause severe tissue necrosis; this can result in contractures and may require skin grafting. Integrity of the IV site should be ascertained before administering calcium through a peripheral vein.
Necrosis of the liver can occur after calcium infusion through an umbilical vein catheter placed in a branch of the portal vein. The position of all umbilical vein catheters must be confirmed radiologically before infusing calcium-containing solutions.
Rapid infusion of calcium-containing solutions through arterial lines can cause arterial spasm and, if administered via an umbilical artery catheter, intestinal necrosis.
Seizures
General medical care in patients with hypocalcemia involves stabilization with management of the patient's airway and breathing if seizures occur. Anticonvulsants are commonly administered before hypocalcemia is confirmed in a new patient. However, seizures usually do not respond to the usual antiseizure medications until calcium is intravenously administered.
Additional considerations
Magnesium administration is necessary to correct any hypomagnesemia because hypocalcemia does not respond until the low magnesium level is corrected.
Administration of phosphate-lowering agents may be necessary if hypocalcemia is associated with hyperphosphatemia.
In certain conditions, such as pancreatitis and rhabdomyolysis, full correction of hypocalcemia should be avoided. After the primary condition is resolved, these patients may develop hypercalcemia due to the release of complexed calcium.
In patients with concurrent acidemia, hypocalcemia should be corrected first. Acidemia increases the ionized calcium levels by displacing calcium from albumin. If acidemia is corrected first, ionized calcium levels decrease.
Diet
A diet high in calcium and low in phosphate is required in most instances. Infants drinking regular cow's milk or evaporated milk must be given humanized infant formula instead. Patients with renal failure should be given a low-solute, low-phosphate formula, such as Similac PM 60/40.
Consultations
Consult with the follow specialists as needed:
- Pediatric endocrinologist
- Geneticist
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Mulligan ML, Felton SK, Riek AE, Bernal-Mizrachi C. Implications of vitamin D deficiency in pregnancy and lactation. Am J Obstet Gynecol. Oct 19 2009;[Medline].
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