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    12 Neonatal Hypocalcemia, Glycemia and Magnesemia

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    Rana Vandana
    This document discusses neonatal hypocalcemia, hypoglycemia, and hypomagnesaemia. It defines each condition and discusses their incidence, etiology, clinical manifestations, diagnostic findings, and management. Key points include that hypocalcemia is defined as a calcium level less than 2.1 mmol/L in children and less than 2 mmol/L in term infants. Hypoglycemia is defined as a glucose level less than 45 mg/dL. Hypomagnesaemia occurs when magnesium levels fall below 0.66 mmol/L. At risk babies should be monitored for these electrolyte imbalances. Intravenous supplementation and careful feeding are used as medical management.

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    12 Neonatal Hypocalcemia, Glycemia and Magnesemia

    Uploaded by

    Rana Vandana
    154 views55 pages
    This document discusses neonatal hypocalcemia, hypoglycemia, and hypomagnesaemia. It defines each condition and discusses their incidence, etiology, clinical manifestations, diagnostic findings, and management. Key points include that hypocalcemia is defined as a calcium level less than 2.1 mmol/L in children and less than 2 mmol/L in term infants. Hypoglycemia is defined as a glucose level less than 45 mg/dL. Hypomagnesaemia occurs when magnesium levels fall below 0.66 mmol/L. At risk babies should be monitored for these electrolyte imbalances. Intravenous supplementation and careful feeding are used as medical management.

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    This document discusses neonatal hypocalcemia, hypoglycemia, and hypomagnesaemia. It defines each condition and discusses their incidence, etiology, clinical manifestations, diagnostic findings, and management. Key points include that hypocalcemia is defined as a calcium level less than 2.1 mmol/L in children and less than 2 mmol/L in term infants. Hypoglycemia is defined as a glucose level less than 45 mg/dL. Hypomagnesaemia occurs when magnesium levels fall below 0.66 mmol/L. At risk babies should be monitored for these electrolyte imbalances. Intravenous supplementation and careful feeding are used as medical management.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    154 views55 pages

    12 Neonatal Hypocalcemia, Glycemia and Magnesemia

    Uploaded by

    Rana Vandana
    This document discusses neonatal hypocalcemia, hypoglycemia, and hypomagnesaemia. It defines each condition and discusses their incidence, etiology, clinical manifestations, diagnostic findings, and management. Key points include that hypocalcemia is defined as a calcium level less than 2.1 mmol/L in children and less than 2 mmol/L in term infants. Hypoglycemia is defined as a glucose level less than 45 mg/dL. Hypomagnesaemia occurs when magnesium levels fall below 0.66 mmol/L. At risk babies should be monitored for these electrolyte imbalances. Intravenous supplementation and careful feeding are used as medical management.

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    © All Rights Reserved
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    Download as pptx, pdf, or txt
    of 55

    NEONATAL HYPOCALCEMIA,

    HYPOGLYCEMIA,
    HYPOMAGNESAEMIA
    HYPOCALCEMIA
    Children – is defined as a total serum calcium
    concentration less than 2.1 mmol/L (8.5
    mg/dL).
    Term infants -less than 2 mmol/L (8 mg/dL) or
    ionized fraction of less than 1.1 mmol/L (4.4
    mg/dL)
    Pre term -less than 1.75 mmol/L (7 mg/dL)
    Normal calcium values
    • Cord = 9-11.5 mg/dl
    • Newborn, 3-24 hours = 9-10.6 mg/dl
    • Newborn, 24-28 hours = 7-12 mg/dl
    • Newborn, 4-7 days = 9-10.9 mg/dl
    Anatomy & physiology
    Epidemiology
    Late onset hypoglycemia –common (developing
    countries)
    Age related demographics -:
    -Mostly new borns
    -older children : associated with
    #critical illness
    #acquired hypoparathyroidism
    #mutations in calcium – sensing receptor
    #defect in Vit.D supply or metabolism
    INCIDENCE
    • 30% VLBW (<1500 g)
    • Infants of diabetic mother
    Etiology
    • In neonates :
    Early onset neonatal hypocalcemia
    Late onset neonatal hypocalcemia
    • In infants and children :
    Hypoparathyroidism,
    Abnormal vitamin d production or action, and
    Hyperphosphatemia
    PATHOPHYSIOLOGY
    DIAGNOSTIC FINDINGS
    • History collection
    • Physical examination
    • Lab .findings
    Lab . Findings
    • Total and ionized serum calcium
    levels
    • Serum magnesium levels
    • Serum electrolyte and glucose
    levels
    • Phosphorus levels
    • Parathormone levels
    • Vitamin D metabolite (25-
    hydroxyvitamin D and 1,25-
    dihydroxyvitamin D) levels
    • Urine calcium, magnesium,
    phosphorus, and creatinine levels
    • Serum alkaline phosphatase
    levels
    Additional tests:
    • Malabsorption workup
    • Total lymphocyte and T-cell
    subset analyses
    • Chest radiography
    • Ankle and wrist
    radiography
    • Electrocardiography
    • Karyotyping
    Management
    1 ml of Ca.gluconate (10%) -9 mg elemental ca.
    EARLY NEOANTAL HYPOCALCEMIA:
     Patients at increased risk of hypocalcemia
     Patients diagnosed –asymptomatic
     Patients diagnosed – symptomatic
     Patients at increased risk of hypocalcemia
    • -pre term + sick (DM) + perinatal asphyxia
    = 40 mg/kg/day
    • -infants (oral feeds)
    calcium PO=q.6 hrly
    • -therapy – continued ---3 days
     Patients diagnosed –asymptomatic

    • -80 mg/kg/day elemental calcium – 48 hrs


    • Tapered 50% --------for another 24 hrs
    • -oral feeds---------PO calcium
     Patients diagnosed – symptomatic

    Bolus ---2ml/kgldose -----5% D-----10 min


    Contin. Infusion-----80mg/kg/day -----48hrs
    50% dropped-----next 24 hrs-----discontinued
    Late Neonatal Hypocalcemia
    • Hypomagnesaemia
    • High phosphate load
    • Hypoparathyroidism
    • Vit .D deficiency
    Hypomagnesaemia
    • Symptomatic hypocalcemia- unresponsive
    = due tohypomagnesaemia
    • 2 doses ---0.2 ml/kg----50% MgSO4 inj(12 hrs)
    deep IM
    • Maintenance dose----0.2 ml/kg/day---3 days
    High phosphate loads
    • EBM-----encouraged
    • Phosphate binding gels---avoided
    Hypoparathyroidism
    • Hyperphosphatemic & hypocalcemic---
    normal renal functions
    • Ca. supple…----50mg/kg/day----3 divided
    doses
    • Vit . D3-----0.5-1 µg/day
    • Syrup shelcal------250 mg/5ml
    Vit .D deficiency states
    Vit . D3 supple…30-60 ng/kg/day
    NURSING MANAGEMENT
    • Assessment
    • Identify the infants at risk
    • Administer supp. Ca, vit .D, phos.
    • Monitor during infusion
    • Nutritional supplementation
    DIAGNOSIS
    • Risk for injury r/t seizures secondary to
    hypocalcemia
    • Ineffective airway clearance r/t laryngospasm
    sec. to hypocalcemia
    • Impaired skin integrity r/t infiltration of
    calcium infusion
    • Ineffective perfusion r/t rapid infusion of
    calcium
    Hypomagnesaemia
    Definition
    Hypomagnesemia occurs when serum
    concentrationsfall below 0.66mmol/L
    (1.6mg/dL)
    ETIOLOGY
    -Decreased
    -Mg loss mg supply
    CLINICAL MANIFESTATIONS
    NEONATALPERIOD –
    • Malabsorption syndrome
    • Intractable hypocalcemic
    seizures
    Management (medical)
    • Should not be treated with Ca.or Vit.D
    • Mg. salts ----can be given
    • 50% solution of MgSO4, 0.005 to 0.1 mL/kg
    (0.1 to 0.2 mmol/kg or 2.5 to 5.0 mg /
    kg )
    slow IV 30-60 MIN
    ……..Repeated doses-q 8-12 hrs
    • Concominant oral Mg suppl
    • if Mal absorption- 1mg/kg/day PO (daily)
    • Serum Mg. conc. Measured
    • Oral MgSO4 --- are not well absorbed---
    diarrhoea
    • Well
    titrated
    Nursing management
    • Assessment
    -fluid balances
    -wt changes
    -skeletal muscle strength(weakness)
    -cardiac rhythm(arrythmia)
    -cerebral func.(LOC)
    -GI func(bowel sounds)
    -neuro muscular excitability
    • Monitor serum Mg. levels
    • Monitor BP
    • Monitor RR & depth
    • Monitor deep tendon reflexes
    • Admin. Drugs
    • Monitor electrolyte balances
    • Parent education
    Complications
    • Hypotonia
    • Respiratory depression
    • Hypotension
    • Cardiac arrythmias
    HYPOGLYCEMI
    A
    DEFINITION:
    Neonatal Hypoglycemia is defined as a plasma
    glucose level of less than mg/dL ( mmol/L)
    in the first 24 hrs of life and less than 45
    mg/dL (2.5 mmol/L) .
    INCIDENCE
    • Differs ----population, method & timing
    of feeding
    • Early feeding ------decreases incidence
    • IBM :
    CHO metabolism disorders(>1:10,000)
    Fatty acid oxidation disorders(1:10,000)
    Hereditary fructose intolerance (1:20,000/50…)
    Glycogen storage diseases(1:25,000)
    Galactosemia
    RISK FACTORS
    1.Decreased substrate availability
    •Intra-uterine fetal growth restriction
    •Glycogen storage disease
    •Inborn errors (e.g., fructose intolerance)
    • Prematurity
    •Prolonged fasting without IV glucose
    2.Hyperinsulinemia
    • Infant of diabetic mother
    •Islet cell hyperplasia
    • Erythroblastosis fetalis
    •Exchange transfusion
    •Beckwith-Wiedemann Syndrome
    •Maternal ß-mimetic tocolytic agents
    •”High” umbilical arterial catheter
    •Abrupt cessation of IV glucose
    3.Other endocrine abnormalities
    •Pan-hypopituitarism
    •Hypothyroidism
    •Adrenal insufficiency
    4.Increased glucose utilization
    •Cold stress
    •Increased work of breathing
    •Sepsis
    • Perinatal asphyxia
    5.Miscellaneous condition
    • Polycythemia
    •Congenital heart disease
    •CNS abnormalities
    GLUCOSE PHYSIOLOGY IN FETUS &
    NEW BORN
    CLINICAL MANIFESTATIONS
    • Infants ---1st/ 2nd day of life ------asymptomatic
    • Hypotonia
    • Lethargy
    • Poor feeding
    • Jitteriness, seizures
    • CHF
    • Cyanosis
    • Apnea
    • Hypothermia
    C/M ---ASSOCIATED WITH ANS
    • Anxiety, tremulouness
    • Diaphoresis
    • Tachycardia
    • Pallor
    • Hunger, nausea, & vomiting
    C/M ---OF HYPOGLYCORRHACHIA
    Head ache
    Mental confusion,
    Staring, behavioral changes
    Difficulty concentrating
    Visual disturbances
    Dysarthria
    Seizures
    Ataxia
    Somnolence
    Coma
    Stroke
    Diagnostic findings
    • Serum or plasma glucose levels
    • Serum insulin
    • Urine for ketone bodies
    • Screening for metabolic errors
    • Angiography
    Management
    • Screening-------1,2,4,6,9,12 hrs
    • At risk neonates-----2,6,12,24,48,72hrs
    • Sick babies, sepsis,
    asphyxia, shock 6-8 hrs

    Asymptomatic babies
    ---with BS 20-40 mg/dL
    –after 1 hr of oral feed
    -later q 6 hrs till 48 hrs ( if BS > 50 mg/dL)
    ----with BS levels < 20 mg/dL
    -after 1 hr of starting IV fluids & then q hr
    ----BS <40 mg/dL-(even after 1 hr of oral feeds)
    - q 6h for 48 hrs
    To calculate rate of glucose
    administration
    • % glucose x mL/kg/d = glucose infusion rate
    (mg/kg/min)
    144
    Or
    • % glucose x mL/h = glucose infusion
    rate (mg/kg/min)
    • 6 x body weight (kg)
    Asymptomatic hypoglycemia
    • Are at risk for neurodevelopment
    • Initially feed---BM/ formula---spoon or gavage
    • Check BS-----30-60 min-before next feed
    • If >45mg/dL---2-3 hrly feed ---q 4-6 hr monitor
    for 48hrs
    • IV Infusion if :
    BS < 25 mg/dL
    BS remains <45 mg/dL
    Enteral feed –contra..
    Baby becomes –
    sympt..
    Symptomatic hypoglycemia
    • Can result in high incidence ----neural inj.
    • Bolus 2mL/kg –10%D—IV
    • Following –IV dextrose (6mg/kg/min)
    • BS –rechecked—after 15-30 min
    • If BS 45 mg/dL ---hrly ---for 4-6 hrly
    • If BS- remains < 45 mg/dL
    GIR---increased 2mg/kg/min q 15-30
    min… (+) checked
    • Tappering glucose infusion –
    Once BS values >45 mg/dL stabilized 24
    hrs infusion is tappered.
     Infusion is tappered @ 2mg/kg/min-q 6hrs
    Oral feeds ca be started if not
    contraindicated
    Nursing management

    • Assessment
    -maternal history
    -immunization
    -family history
    -sepsis
    -enteral feeding
    -use of corticosteroids
    -drug addiction
    -cancer
    Nursing Diagnosis
    • Risk for complications related to lower plasma
    glucose levels such as mental disorders,
    behavioral disorders, autonomic nerve
    function disorders, hypoglycemic coma
    Nursing Diagnosis
    • Risk for infection related to a decrease in
    endurance

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