The severity of clinical symptoms of hypocalcemia is not completely consistent with the degree of hypocalcemia, but it is related to the speed and duration of hypocalcemia. Blood calcium drops rapidly, even if the blood calcium level is 2mmol/l, it will cause some symptoms. The clinical manifestations of hypocalcemia are mainly related to the increase of neuromuscular excitability, that is, to the convulsions of patients' hands and feet.
Most children with hypocalcemia have limb convulsions, and some children have convulsions accompanied by screaming, shortness of breath or pause, laryngeal spasm, cyanosis of face and lower limbs, and their expressions are extremely painful. A considerable part of them will have abdominal distension and obvious systemic edema.
At the same time, to sum up, hypocalcemia actually has the following symptoms:
1, limb twitching, mental irritability, cognitive decline and other symptoms.
Muscle spasms may occur and early peripheral nervous system numbness may occur. Mild convulsions can be induced, and severe hypocalcemia can lead to throat, wrist, foot, bronchial convulsions, seizures and even apnea. Mental symptoms such as irritability, depression and cognitive decline may also occur.
2. Symptoms of cardiovascular system, such as arrhythmia.
It is mainly arrhythmia such as conduction block, ventricular fibrillation in severe cases, and adverse reaction of digitalis in heart failure. The typical manifestations of ECG are obviously prolonged QT interval and ST segment.
3, bones and skin, soft tissue and other symptoms, such as bone pain, osteomalacia, itchy skin inelastic, fragile teeth and so on.
Chronic hypocalcemia can be manifested as bone pain, pathological fracture, skeletal deformity and so on. According to the basic etiology, bone diseases can be osteomalacia, osteoporosis, rickets, fibrocystic osteitis and so on. Patients with chronic hypocalcemia often have dry skin, inelastic skin, dark color and itching; It is also prone to thinning hair, brittle nails and brittle teeth. Cataracts caused by hypocalcemia are more common.
4. Severe seizures, asthma and asphyxia will occur when hypocalcemia is severe.
When the blood calcium is lower than 0.88mmol/L(3.5mg/dl), severe voluntary and smooth muscle spasms may occur, leading to convulsions, seizures and severe asthma. Severe symptoms can cause laryngeal muscle spasm, asphyxia, cardiac insufficiency and cardiac arrest.
Causes of hypocalcemia The causes of hypocalcemia are very complicated, and it is difficult for us to clearly judge the specific reasons, but I will give you a general summary of some common causes of hypocalcemia to help mothers understand and understand the situation of hypocalcemia in their babies, so as to facilitate the treatment and care of their babies in the future.
Under normal circumstances, most hypocalcemia babies have a history of hypoxia or acute dystocia at birth, with poor reaction after birth, irritability, limb jitter, convulsions and vomiting. After examination, there are nervous system depression or excitement such as increased or decreased muscle tension, full anterior fontanel, and changes in respiratory frequency or rhythm.
Generally speaking, hypocalcemia is generally caused by the following reasons.
1, hypoparathyroidism.
(1) Parathyroid hormone release disorder.
(2) Parathyroid hormone dysfunction (hormone resistance).
(3) Pseudohypoparathyroidism.
2. The function of parathyroid hormone is normal or increased.
(1) Renal failure.
(2) intestinal malabsorption.
(3) Acute or chronic pancreatitis.
(4) Osteoblast metastasis.
(5) vitamin d deficiency or resistance.
3, drugs: ① used to treat hypercalcemia and bone cancer, absorbed too many drugs, such as bisphosphonates, pokacin (phototmycin), calcitonin, phosphate, etc. ② anticonvulsants: for example, phenobarbital can lead to hypocalcemia by changing vitamin D metabolism. ③ Calcium chelating agent: EDTA and citric acid are commonly used. ④ Phosphoric acid: It can chelate calcium in extracellular fluid, leading to hypomagnesemia.
4. The influencing factors of neonatal hypocalcemia are: abnormal tissue, birth weight, hyponatremia, hypoglycemia, premature delivery, intracranial hemorrhage, etc. The incidence of hypocalcemia in newborns with scalp hematoma, traction soft tissue contusion and skin injury infection increased significantly, which may be related to the need for calcium during coagulation.
5. Hypocalcemia associated with malignant tumor: Osteoblast metastasis of prostate cancer or breast cancer can accelerate bone formation and lead to hypocalcemia. In addition, a large number of tissues are destroyed during chemotherapy for lymphoma and leukemia, so that phosphate is released into the blood and blood calcium can be significantly reduced, which is called tumor lysis syndrome.
6. Others: acute hemorrhagic necrotizing pancreatitis, fat necrosis can precipitate a lot of calcium to form calcium; Rhabdomyolysis can also produce similar symptoms.
In a word, hypocalcemia is caused by many factors, which can aggravate encephalopathy and intracranial hemorrhage. Calcium supplementation may also cause intracellular calcium overload and aggravate brain injury. The key to prevent hypocalcemia is to actively carry out education, prevent premature delivery, asphyxia and tissue damage, and adjust the vital signs and electrolyte balance of newborns within 1 week.
Types of hypocalcemia The causes of hypocalcemia in newborns are different from those in adults and children. Generally speaking, it is not only related to dystocia at birth, but also related to the mother's physical discomfort and improper feeding. The causes of neonatal hypocalcemia are divided into the following three aspects:
1, early hypocalcemia
It occurs within 48 hours after birth and is common in: low birth weight infants, various dystocia infants and children with intracranial hemorrhage, asphyxia, RDS, septicemia and hypoglycemia; Or after applying alkaline solution to correct acidosis; Or pregnant women with diabetes, pregnancy-induced hypertension syndrome, prenatal hemorrhage, dietary calcium and vitamin D deficiency and hyperparathyroidism. Their newborn babies are prone to hypocalcemia.
2. Late hypocalcemia
It is pointed out that hypocalcemia occurring 48 hours after birth is mostly full-term infants. It mainly happens to artificially fed babies. Because milk substitutes and cereal foods made of milk and soybean powder have high phosphorus content, the proportion of calcium and phosphorus in milk is low, which is not conducive to calcium absorption. Neonates' relatively high phosphate intake and low glomerular clearance lead to hyperphosphatemia and hypocalcemia.
In addition, insufficient intake of vitamin D during pregnancy, treatment of neonatal metabolic acidosis with sodium bicarbonate, or use of sodium citrate as anticoagulant during blood exchange can reduce free calcium and lead to hypocalcemia.
3. Other hypocalcemia
It is common in infants with vitamin D deficiency or congenital hypoparathyroidism, and hypocalcemia lasts longer.
(1) Hyperparathyroidism. The increase of maternal blood calcium can cause fetal hypercalcemia, and the fetal parathyroid gland is inhibited, and its parathyroid gland is larger than that of normal infants, with persistent symptoms; However, the application of calcium can finally relieve convulsions, and sometimes the course of treatment often lasts for several weeks, which may be accompanied by hypomagnesemia. The mother's condition can be hidden without clinical symptoms, and the parathyroid lesions of the mother can also be found because of the intractable hypocalcemia convulsion of the baby.
(2) Temporary congenital idiopathic hypoparathyroidism is a benign primary disease, and the maternal parathyroid function is normal. In addition to calcium therapy, you should also use appropriate amount of vitamin D for several months.
(3) Permanent hypoparathyroidism. This is rare, with persistent hypoparathyroidism and hyperphosphatemia.
How to treat hypocalcemia What should we do if our baby unfortunately suffers from hypocalcemia? In addition to being sent to the hospital for treatment in time, we should also pay attention to the changes in the child's physical condition in daily life and give appropriate care.
In the treatment of this disease, children with acute convulsions should be given calcium intravenously in the hospital, and sedatives should be used to stop convulsions. After the symptoms are controlled, give the child oral calcium supplementation and vitamin D supplementation.
1, take calcium supplement according to the doctor's advice.
1) 10% calcium gluconate is diluted at least twice with 5% ~ 10% glucose solution for intravenous injection or intravenous drip, and the injection speed of diluted liquid medicine is
2) During the whole process of intravenous medication, the infusion should be smooth to avoid local tissue necrosis caused by drug overflow. Once the liquid medicine is found to overflow, the needle should be pulled out immediately to stop injection, and 25% ~ 50% magnesium sulfate should be used for local wet compress.
3) When taking calcium orally, it should be given between feeding, and it is forbidden to mix with milk, which will affect calcium absorption.
4) Prepare suctioner, oxygen, tracheal intubation, tracheotomy and other first aid supplies. In case of emergency such as laryngeal spasm, it is convenient to organize rescue against time.
2. Do a good job in family education.
1) Introduce the knowledge of neonatal hypocalcemia nursing, encourage breastfeeding and get more sunshine. If breastfeeding is not allowed, breast-fed formula should be given to ensure calcium intake. Or supplement calcium and vitamin d during breastfeeding.
2) Parents should be reminded that the clinical manifestations of early hypocalcemia are very different, not necessarily parallel to the blood calcium concentration, and the symptoms may be atypical or asymptomatic. Therefore, parents need to closely observe the baby's mental condition and do a good job in neonatal care. Babies with a history of abnormal delivery need to be highly alert to this disease if they have fidgety crying, restless sleep, trembling, frequent facial muscle twitching or hypotonia, apnea, and low milk production.
3. Nursing care of hypocalcemia
1) Hypocalcemia is not effective after calcium supplementation and vitamin D supplementation. It is necessary to consider whether hypomagnesemia is complicated and supplement it after it is clear.
2) Patients who use digitalis should be careful to use intravenous calcium supplementation, otherwise it will easily lead to digitalis poisoning.
3) Patients with hypocalcemia should avoid and correct alkalosis as much as possible, especially those who use ventilators. Hyperventilation may lead to alkalosis and aggravate the symptoms of hypocalcemia.
How to prevent hypocalcemia may be difficult to avoid, but a considerable part of hypocalcemia is actually related to the physical condition of pregnant women and the feeding of babies, which can be prevented from the source and avoid tragedies. The following are some precautions to prevent hypocalcemia:
1, actively control the primary disease and have regular physical examination. Hypocalcemia is easy to occur after thyroid or parathyroid surgery.
2. Increase sunlight exposure and proper nutrition to prevent hypocalcemia and chronic diarrhea caused by malnutrition.
3. calcium supplementation is not everything. Postmenopausal women or patients with osteoporosis, such as those who take calcium and vitamin D preparations for a long time, should drink plenty of water and regularly detect blood calcium and urine calcium levels to prevent hypercalcemia caused by calcium supplementation.
4. If breastfeeding is not allowed, breast-fed formula milk should be given to ensure calcium intake. Or supplement calcium and vitamin d during breastfeeding.