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20 - Hypocalcaemia

Published online by Cambridge University Press:  15 February 2010

Amanda Ogilvy-Stuart
Affiliation:
University of Cambridge
Paula Midgley
Affiliation:
University of Edinburgh
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Summary

Clinical presentation

  • Incidental asymptomatic hypocalcaemia on blood results (usual presentation).

  • Neuromuscular irritability: myoclonic jerks, jitteriness, exaggerated startle responses, seizures.

  • Apnoea, cyanosis, tachypnoea, vomiting, laryngospasm.

  • Cardiac symptoms and signs: tachycardia, heart failure, prolonged QT interval on electrocardiogram (ECG), decreased contractility. Severe vitamin D deficiency may present with cardiomyopathy.

Definition

Total calcium <2.2 mmol/L/ionized calcium <1.2 mmol/L.

  • Note: physiological hypocalcaemia occurs after birth as the transplacental calcium supply is cut, there is insufficient supply from the GI tract and insufficient release of parathyroid hormone (PTH) from the immature parathyroid gland.

  • Total calcium levels drop to about 2 mmol/L and ionized to about 1 mmol/L.

  • The nadir in calcium level occurs within the first 48 h.

Approach to the problem

Hypocalcaemia is common, it is usually due to one of the following:

  • Physiological, or an exaggeration of the normal physiological response.

  • Iatrogenic and short lasting.

Other causes of hypocalcaemia are rare.

Aetiologies are conventionally grouped according to the time of onset:

  • Early: within the first 4 days of life.

  • Late: after 4 days of age.

History: Preterm, birth depression, infant of a diabetic mother, abnormality in maternal calcium metabolism.

Examination:

  • Symptoms and signs of hypocalcaemia as above.

  • […]

Type
Chapter
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Publisher: Cambridge University Press
Print publication year: 2006

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  • Hypocalcaemia
  • Amanda Ogilvy-Stuart, University of Cambridge, Paula Midgley, University of Edinburgh
  • Book: Practical Neonatal Endocrinology
  • Online publication: 15 February 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544736.021
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  • Hypocalcaemia
  • Amanda Ogilvy-Stuart, University of Cambridge, Paula Midgley, University of Edinburgh
  • Book: Practical Neonatal Endocrinology
  • Online publication: 15 February 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544736.021
Available formats
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Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Hypocalcaemia
  • Amanda Ogilvy-Stuart, University of Cambridge, Paula Midgley, University of Edinburgh
  • Book: Practical Neonatal Endocrinology
  • Online publication: 15 February 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544736.021
Available formats
×