Morning Report 9-25

Morning Report Nate Ostheimer 09/25/09

Calcium Levels in Infant  Ca transferred via placenta to infant  Levels: Ca=10 mg/dL, iCa=1.5 mmol/L  Level falls after birth  Ca=8-9 mg/dL, iCa=1.1-1.35  Reach levels of older children and adults by 2

weeks of age

Symptoms of Hypocalcemia  Asymptomatic  Jittery  Chvostek’s sign  Trousseau’s  Seizures  Stridor and laryngospasm  Arrhythmia

Hypocalcemia in the Infant  Early-within 3 days of birth  Exaggeration of normal decline of calcium  Prematurity-hypoalb, decr milk intake, impaired response to PTH, increased calcitonin, increased renal excretion,  Diabetic moms-lower [PTH]?  Birth asphyxia-incr phos due to tissue catabolism  IUGR-decr Ca transfer across placenta  Gentamicin-case report  Maternal vitamin D deficiency-rare

Hypocalcemia in Infant Late-typically at end of first week  Hypoparathyroidism:  DiGeorge-failure of migration of neural crest cells to 3rd and 4th pharyngeal pouch  Maternal hyperparathyroidism-incr transplacental transport of Ca suppresses neonatal PTH secretion  Hypomagnesemia-resistance to PTH and impraired PTH secretion  High phosphate intake: cow’s milk/cow’s milk formula [high

phos]  NICU babies-HCO3 admin; transfusion of citrated blood (Ca complexes)  Hypovitamin D