Hypocalcemia in the critically ill child

ABSTRACT

This study was carried out on 39 critically ill infants and children at the New Children's Hospital of Cairo Univeristy to detect the frequency of hypocalcemia and derangements in calcium homeostasis among the critically ill children. The children were grouped into four groups; cardiac, respiratory, neurological and renal, with 10 normal infants and children as a control group. Determination of total serum calcium, serum ionized calcium, arterial blood pH and serum albumin were done. Results showed that total serum calcium was in all groups, serum ionized calcium was significantly lower in all groups except the neurological one, albumin was low in the renal group only, arterial pH was different from the control group in all other groups except the cardiac one. It was also observed that decreased serum albumin leads to decreased total calcium, increased pH leads to decrease ionized calcium and vice versa. Correlation between total and ionized calcium showed a +ve significant correlation in all groups except the renal group. Therefore, it is indicated that hypocalcemia is a common, unrecognized problem in the critically ill pediatric patient. The total serum calcium concentration is a poor predictor for those patients while serum ionized calcium value is a better predictor for the more clinically relevant cases. For that reason, it is recommended to measure serum ionized calcium in critically ill children and consequently calcium administration, specially in those suffering from multisystem derangements, even if the total serum calcium is within normal value