Infants hypocalcemia

In general, most of the routine biochemical tests in these cases are within normal limits. However, some of the older children had slightly or moderately impaired liver function, as shown by the raised alkaline phosphatase and transaminases. Even in the neonates who were more severely affected, the results were similar. In one infant, hypocalcemia was also present (B2). 

It has been stated that idiopathic hypercalcemia has not been known to develop in a wholly breast-fed infant (B6). Morgan et al. (M3), however, have described an infant who was still breast fed at the time of diagnosis at 8 months of age and whose intake of cow s milk consisted only of that present in puddings and other cereal foods. The association between artificial feeding and idiopathic hypercalcemia has been related to the fact that the calcium content of cow s milk is four times that of human milk. On the other hand the phosphorus content of cow s milk is also higher, and this has been suggested as a cause of hypocalcemia in infants (G2). 

Parathyroid Hormone Parathyroid hormone raises plasma calcium by direct effects on bone resorption and renal reabsorption of calcium, and indirectly by regulating the metabolism of vitamin D. It is a peptide and acts via cell surface G-protein receptors linked to adenylate cyclase. The parathyroid glands have G-protein cell surface calcium receptors linked to phospholipase G, and parathyroid hormone is secreted in response to hypocalcemia. Magnesium is required for secretion of the hormone, which may explain the development of hypocalcemia in premature infants who are magnesium deficient. 

Hypocalcemia commonly occurs during the first I or 2 days of life in premature, low-birth-weight infants. The exact mccKaiusm is not clear. Hypocalcemia can also present in newborns fed cow milk, because cow milk contains calcium and phosphorus in a ratio of about 1.34/1.0, by weight. Mother s milk contains relatively less phosphate the calcium/phosphorus ratio is 2.25/1,0. The excess phosphate in cow milk promotes hyperphosphatemia in the newborn. It is thought that plasma phosphate, in elevated concentrations, fonns a complex with plasma calcium. Formation of this complex reduces the levels of free calcium, resulting in symptoms of hypocalcemia. The newborn is not as able to make hormonal adjustments to maintain plasma calcium levels as is the older infant (Mizrachi et al., 1968). 

Klein GL, Snodgrass WR, Griffin MP, Miller NL, Alfrey AC. Hypocalcemia complicating deferoxamine therapy in an infant with parenteral nutrition-associated aluminum overload evidence for a role of aluminum in the bone disease of infants. J Pediatr Gastroenterol Nutr 1989 9(3) 400-3. 

The RDA for calcium in adults over the age of 24 is 0.8 g. The RDA for women during pregnancy and lactation is 1.2 g. The increased level of 1.2 g is required to supply the fetus with the 30 g of calcium present in the newborn and to provide the 0.24 g of calcium secreted in the milk each day. The RDA for persons from 11 to 24 years of age is 1.2 g the RDAs for children (0.8 g) and infants (0.6 g) are lower. Eggs supply about 30% of dietary calcium and 30% of dietary phosphate for the overall population in the United States. Meat, poultry, and fish supply 20-25% of our phosphate, but only 10% of our calcium. Milk and dairy products supply 20-25% of our phosphate, and 50% of our calcium (Calvo and Park, 1996). A dietary deficiency in calcium is quite rare, though calcium nutrition receives much attention because of mainstream health concerns related to calcium, such as osteoporosis, hypercalcemia, and hypocalcemia. 

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Reference Intervals. Plasma or serum total calcium concentrations vary with age. Premature infants tend to exhibit hypocalcemia whereas full-term neonates have higher levels than adults. The 95% confidence range in children, ages 4-20 years, is 2.30-2.75 mmol/liter [16-18]. The mean adult total calcium concentration is 2.35 mmol/liter with 95% confidence range from 2.20 to 2.55 mmol/liter. Five percent lower means have been reported for persons over 50 years [19]. The quoted reference intervals should be taken as an indication of expected values but each laboratory should establish its own reference intervals depending on the assay method and the population of interest. 

She also increased in body length by 5.5 cm, head circumference by 6.5 cm and chest circumference by 8.5 cm. The infant was maintained in positive nitrogen, sodium, and potassium balances throughout this period of time. The importance of balance studies is indicated by the calcium and phosphorus metabolism in this infant. Insufficient calcium and phosphorus were provided to produce positive balances until day 20. Hypophosphatemia and hypocalcemia will regularly result if phosphorus and calcium are not provided in adequate amounts in the nutritional solution daily (Ruberg et al., 1971). 

Relative active or latent peptic ulcer disease, recent intestinal anastomoses, nonspecific ulcerative colitis (increased risk of perforation), diabetes, adrenocortical insufficiency (may persist for months after discontinuing therapy), active or latent tuberculosis, cerebral malaria, chicken pox, meades, latent amebiasis or strongyloides infection, inactivated viral or bacterial vaccines where antibody response may not be induced, cirrhosis, congestive heart failure, renal failure or hypertension (increased risk of sodium retention, edema and potassium loss), hypokalemia or hypocalcemia, emotional instability or psychotic tendencies, hypothyroidism, growth retardation in infants and children. 

Hypocalcemia has previously been described in connection with deferoxamine in an 8-month-old infant with aluminium overload related to parenteral nutrition, without increased urinary calcium excretion, suggesting bone uptake of calcium after chelation of aluminium [21 ]. A similar hypocalcemic effect has been observed in two patients with dialysis-related aluminium-induced osteomalacia treated with deferoxamine 12 ... 

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