Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Pediatric Hypocalcemia Treatment & Management

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

Approach Considerations

Treatment of asymptomatic patients with hypocalcemia remains controversial, especially with regard to neonates. Some authorities suggest that treating such patients is unnecessary. Most newborns with hypocalcemia remain asymptomatic and can be treated in a regular newborn nursery. If persistent, the newborns can be treated with special formula PM 60/40 that provides 2:1 calcium-to-phosphate ratio. Oral calcium supplements can be added to increase the calcium-to-phosphorus ratio to 4:1 to correct the hypocalcemia until PTH function normalizes.

Most clinicians agree, however, that hypocalcemia should be promptly treated 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 on a radiograph 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 antiepileptic 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
 
 
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].

 
Previous
Next
 
Electrocardiogram (ECG) findings in severe hypocalcemia.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.