A Case of Severe Neonatal Hypocalcemia Treated With Continuous Enteral Calcium

Julia R. Donner, MD; Avani Ganta, MD; Lee Polikoff, MD; Linda Snelling, MD; Monica Serrano-Gonzalez, MD

AACE Clinical Case Reports (May 2023)

A Case of Severe Neonatal Hypocalcemia Treated With Continuous Enteral Calcium

Julia R. Donner, MD,
Avani Ganta, MD,
Lee Polikoff, MD,
Linda Snelling, MD,
Monica Serrano-Gonzalez, MD

Affiliations

Julia R. Donner, MD: Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
Avani Ganta, MD: Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island; Division of Pediatric Endocrinology, Hasbro Children’s Hospital, Providence, Rhode Island
Lee Polikoff, MD: Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island; Division of Pediatric Critical Care Medicine, Hasbro Children’s Hospital, Providence, Rhode Island
Linda Snelling, MD: Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island; Division of Pediatric Critical Care Medicine, Hasbro Children’s Hospital, Providence, Rhode Island
Monica Serrano-Gonzalez, MD: Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island; Division of Pediatric Endocrinology, Hasbro Children’s Hospital, Providence, Rhode Island; Address correspondence to Dr Monica Serrano-Gonzalez, Division of Pediatric Endocrinology, Hasbro Children’s Hospital, 593 Eddy Street, Providence, RI 02903.

Journal volume & issue: Vol. 9, no. 3
pp. 85 – 88

Abstract

Read online

Background/Objective: Hypocalcemia is a common, treatable cause of neonatal seizures. The rapid repletion of calcium is essential for restoring normal calcium homeostasis and resolving seizure activity. The accepted approach to administer calcium to a hypocalcemic newborn is via peripheral or central intravenous (IV) access. Case Report: We discuss a case of a 2-week-old infant who presented with hypocalcemia and status epilepticus. The etiology was determined to be neonatal hypoparathyroidism secondary to maternal hyperparathyroidism. Following an initial dose of IV calcium gluconate, the seizure activity abated. However, stable peripheral intravenous access could not be maintained. After weighing the risks and benefits of placing a central venous line for calcium replacement, it was decided to use continuous nasogastric calcium carbonate at a rate of 125 mg of elemental calcium/kg/d. Ionized calcium levels were used to guide the course of the therapy. The infant remained seizure-free and was discharged on day 5 on a treatment regimen that included elemental calcium carbonate, calcitriol, and cholecalciferol. He remained seizure free since discharge and all medications were discontinued by 8 weeks of age. Discussion: Continuous enteral calcium is an effective alternate therapy for restoration of calcium homeostasis in a neonate presenting with hypocalcemic seizures in the intensive care unit (ICU). Conclusion: We propose that continuous enteral calcium be considered as an alternative approach for calcium repletion in neonatal hypocalcemic seizures, one that avoids the potential complications of peripheral or central IV calcium administration.

Published in AACE Clinical Case Reports

ISSN: 2376-0605 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the endocrine glands. Clinical endocrinology
Website: https://www.journals.elsevier.com/aace-clinical-case-reports

About the journal

Abstract

Keywords