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Effect of intravenous calcium infusions on serum chemistries in neonates
P S Venkataraman1, G J Sanchez, M K Parker
1Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City 73190.
Insights
Intravenous calcium gluconate bolus infusions in newborns can cause metabolic acidosis and lower phosphorus levels. Higher concentrations (10%) may also increase serum osmolality, while free bilirubin remains unaffected.
Area of Science:
- Neonatal Medicine
- Pediatric Pharmacology
- Biochemistry
Background:
- Intravenous calcium administration is common in neonatal care.
- Potential side effects of rapid calcium infusions require careful evaluation.
- Understanding the impact of calcium gluconate on neonatal metabolic parameters is crucial.
Purpose of the Study:
- To investigate the effects of intravenous bolus calcium gluconate on neonatal metabolic acidosis.
- To assess changes in serum osmolality, free bilirubin, and phosphorus concentrations.
- To determine if calcium concentration influences these metabolic changes.
Main Methods:
- Study included 36 newborn infants receiving intravenous bolus calcium (18 mg/kg elemental calcium) as 5% or 10% calcium gluconate over 10 minutes.
- Monitored blood ionized calcium (iCa), pH, serum osmolality, free bilirubin, and phosphorus.
- Compared outcomes between different calcium gluconate concentrations.
Main Results:
- Significant increase in blood ionized calcium (iCa) observed.
- Significant decrease in blood pH (metabolic acidosis) and serum phosphorus levels.
- 10% calcium gluconate significantly increased serum osmolality; 5% solution did not. Serum free bilirubin remained unchanged.
Conclusions:
- Intravenous bolus calcium infusion in neonates can induce metabolic acidosis and decrease serum phosphorus.
- The concentration of calcium gluconate impacts serum osmolality changes.
- Serum free bilirubin levels are not significantly altered by this intervention.
Abstract:
In 36 newborn infants admitted to the Children's Hospital of Oklahoma, we studied the hypotheses that intravenous bolus infusions of Ca as calcium gluconate over 10 min may (a) result in acute metabolic acidosis, (b) increase serum osmolality, (c) increase serum free bilirubin, and (d) decrease serum phosphorus concentrations. All infants received 18 mg/kg of elemental calcium, as either a 5 or 10% solution of calcium gluconate. Blood ionized calcium (iCa) rose significantly with i.v. bolus Ca infusion (p less than 0.005) and blood pH and serum P declined significantly (p less than 0.05) with i.v. bolus Ca infusion in infants. Serum free bilirubin was not significantly altered. Serum osmolality rose significantly from baseline with bolus infusion of Ca as a 10% calcium gluconate solution and did not change significantly with bolus infusion of a diluted 5% solution. In neonates, intravenous bolus calcium infusion (a) decreases blood pH, (b) infusion of 10% but not 5% calcium gluconate increases serum osmolality, (c) serum free bilirubin concentrations were not altered, and (d) serum phosphorus concentrations were decreased.