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Hypocalcaemia in severe meningococcal infections
P B Baines1, A P Thomson, W D Fraser
1Paediatric Intensive Care Unit, Royal Liverpool Children's Hospital, Eaton Rd, Liverpool L12 2AP, UK. p.baines@liverpool.ac.uk
Insights
Hypocalcaemia, or low calcium levels, is common in critically ill children with meningococcal disease. Sicker children experienced lower calcium concentrations, indicating a link to disease severity.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Endocrinology
Background:
- Meningococcal disease can lead to severe illness in children.
- Electrolyte imbalances, such as hypocalcaemia, may occur in critical illness.
- The incidence and clinical correlates of hypocalcaemia in pediatric meningococcal disease are not well-established.
Purpose of the Study:
- To determine the incidence of hypocalcaemia in critically ill children diagnosed with meningococcal disease.
- To investigate the relationship between calcium levels and disease severity, fluid resuscitation, and relevant hormones.
Main Methods:
- Prospective cohort study of 80 consecutive pediatric intensive care admissions for meningococcal disease.
- Measurement of total and ionised calcium on admission for all patients.
- Measurement of parathormone and calcitonin in a subset of patients.
Main Results:
- Hypocalcaemia (low total and ionised calcium) was observed in 70% of the children.
- Lower calcium concentrations were strongly correlated with increased disease severity.
- A weak association was found between calcium levels and the volume of colloid fluid administered.
Conclusions:
- Hypocalcaemia is a frequent complication in critically ill children with meningococcal disease.
- Disease severity is a significant factor associated with hypocalcaemia in this population.
Aim:
To determine the incidence of hypocalcaemia in critically ill children with meningococcal disease.
Methods:
In a prospective cohort study, 70 of 80 patients admitted consecutively with a clinical diagnosis of meningococcal disease to intensive care had measurements of total and ionised calcium on admission. Parathormone and calcitonin were measured in a proportion of the children.
Results:
Total and ionised calcium concentrations were low in 70% of the children. There was a weak relation of calcium concentration to the volume of blood derived colloid which had been given, but a good relation to disease severity, where sicker children had lower calcium concentrations. Although the parathormone concentration was higher in children with lower calcium concentrations, some children had low ionised calcium concentrations, without an increase of parathormone concentration. Serum calcitonin concentration was not related to calcium concentrations.
Conclusion:
Hypocalcaemia is common in meningococcal disease.