NEONATAL

HYPOCALCEMIA
Presented by:
Ms. Manisha Thakur
Nursing Tutor
Child Health Nursing
INTRODUCTION
• Hypocalcemia is a common metabolic problem in
newborn period and infancy which may lead to many
clinical sign and symtoms. The prematurity have
higher risk of developing hypocalcemia.

DEFINITION
• Hypocalcemia is defined as total serum calcium
concentration of less than 8.5 mg/dl in children, less
than 8 mg/dl in term neonates and less than 7 mg/dl in
preterm neonates.
Mechanism
• Serum calcium level is affected from the serum levels
of phosphate, magnesium, bicarbonate(increase protien
binding with Ca leading to decrease free Ca level). 
• Parathyroid gland release PTH(parathyroid hormone)
which maintains phosphorus and calcium level.
• Phosphorus and calcium are inversely proportional to
each other. That means when ph increases than
calcium decreases.
• Vitamin D helps in the absorption of Ca from intestine.
• Magnesium helps in the absorption of the calcium.
Etiology
• Vitamin D deficiency: malabsorption, malnutrition,
prolonged phenytoin therapy, congenital rickets.
• Metabolic causes: hypoparathyroidism, hypomagnesemia.
• Increased ca loss from the body: hypercalciuria, prolong
corticosteroid, prolong frusemide therapy.
• Other causes: metabolic alkalosis, prematurity, infant with
high phosphate content e.g. cows milk
• Infant of Diabetic mother.
• transfusion with citrate blood
• Di Gerorge syndrome( parathyroid gland smaller in size)
• PHOTOHERAPY
Pathophysiology
Due to etiology

Low calcium level increases the excitation of neurons

This lead to greater excitability in sensory and motor nerves

Hence producing wide range of effect: paresthesia, tetany and

seizures
Clinical manisfestation
Early onset hypocalcemia Late onset hypocalcemia
Occurs with 48-72 hours of birth Occurs after 3-7 days after birth

• High pitch cry • Irritability or jitterness

• Cyanosis • Muscular twitching
• Edema • Tremors
• Vomiting • Convulsions
• Abdominal distention • Chvostek’s sign positive:
• apnea light tap on the cheek
stimulates facial nerve and
lead to abnormal spasm of
facial muscle.
Trousseau’s sign is positive:
b.p cuff is placed around the
arm and inflated to pressure
and held in 3 mintues. This
will occlude the brachial
artery. In absence of blood
flow, the patient’s
hypocalcemia and subsequent
neuromuscular irritabilty will
induce spasm of muscle of
hand and forearm. The wrist
and metacarpophalangeal
joint flexes and finger adduct.
Diagnostic evaluation
• H/O mother: infant of diabetic mother have hypocalcemia
• Estimation of gestational age of neonates: preterm have
hypocalcemia.
• Blood investigation: calcium, phosphate, mg
• Hormone assay: parathyroid hormone estimation is done.
• Ski gram/X-ray of hands show signs of tetany.
Management
• Ca therapy is the mainstay of treatment of hypocalcemia. 10%
calcium gluconate is administered in dose of 2ml/kg,
intravenously to control seizures.

5 ml/kg/day of 10% calcium gluconate

Oral calcium therapy

• Mg administration is necessary to correct any hypomagnesemia

because hypocalcemia does not respond until low mg level is
corrected.
Nursing management
•  Assessment
• Identify the infants at risk
• Administer supp. Ca, vit .D, phos.
• Monitor during infusion
• Nutritional supplementation
NURSING 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