Hypocalcemia Clinical Trial
Official title:
Profile of Hypocalcemia in Infants and Children Admitted to Assiut University Children Hospital
Hypocalcemia is defined as reduction in the level of the ionized calcium in the blood to less
than 0.95 mmole/ litre.
In some cases it is associated with symptoms such as neuromuscular impairment in the form of
convulsions ,carpopedal spasm,parathesia ,laryngiospasm ,stridor……etc .Calcium circulates in
blood stream in three fractions :protein bound to calcium,primarly to albumen(40%) and in 50%
of the cases calcium is present in the ionized state which is physiologically active (Dias ,c
et a l, 2013) . Symptomatizing hypocalcemia may occur in cases of vitamin D deficiency
rickets (nutritional deficiency in infants less than two years ) .It may also occur in
vitamin D resistant rickets e.g renal rickets because of failure of the kidney to synthesize
1-OH cholecalciferol of the 1-25 di-OH cholecalciferol (the active form of vitamin D).
Hypocalcemia is defined as reduction in the level of the ionized calcium in the blood to less
than 0.95 mmole/ litre.
In some cases it is associated with symptoms such as neuromuscular impairment in the form of
convulsions ,carpopedal spasm,parathesia ,laryngiospasm ,stridor……etc .Calcium circulates in
blood stream in three fractions :protein bound to calcium,primarly to albumen(40%) and in 50%
of the cases calcium is present in the ionized state which is physiologically active (Dias ,c
et a l, 2013) . Symptomatizing hypocalcemia may occur in cases of vitamin D deficiency
rickets (nutritional deficiency in infants less than two years ) .It may also occur in
vitamin D resistant rickets e.g renal rickets because of failure of the kidney to synthesize
1-OH cholecalciferol of the 1-25 di-OH cholecalciferol (the active form of vitamin D). In
some cases the liver fails to synthesize the 25-OH group of the active 1-25 di hydroxy
cholecalciferol . In cases of malabsorption hypocalcemia may occur because of lack of
absorption of both calcium and vitamin D from the gastrointestinal tract.
Symptomatizing Ionized hypocalcemia has been reported as an early event associated with organ
dysfunction in children admitted to intensive care unit. This suggests that hypocalcemia may
occur in association with other causes than those mentioned above. It has been reported in
cases with sepsis, shock and in association with the use of anticonvulsants. It may occur in
cardiac arrythmia and tetany (Khadilkar,V & Khadilkar,V,2017).
Regulation of calcium haemostasis is done by two principle hormones: vitamin D and
parathyroid hormone.
These hormones act on three target organs: the intestine, the kidney and bones. In cases of
advanced vitamin D deficiency rickets and in cases of vitamin D resistant rickets
compensatory hyperparathyroidism may occur.( Basatemur & Sutcliffe,2015) Research question:
to find out the causes and differential diagnosis of syptomatizing hypocalcemia in infants
and children admitted to Assiut University Children Hospital using the available datafrom the
literature.
The current strategy for dealing with this problem will be described using an algorithm
covering the various clinical presentations and investigations to reach the final diagnosis
guided by( Fukomoto,S et al,2008 , Pacaud,D & Dawrant ,J,2007 as well as Kelly,A &
Levine,M,2013)
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