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Published on: October 19, 2014
Calcemic response to burns differs between adults and children: A review of the literature
Gordon L Klein1,2, Debra A Benjamin2,3, David N Herndon2,3
1Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX, USA.
Insights
Children and adults show different responses to severe burns regarding calcium and parathyroid hormone (PTH) levels. This difference, linked to the calcium-sensing receptor (CaSR), may influence inflammation in burn patients.
Area of Science:
- Biochemistry
- Pediatric Endocrinology
- Trauma Medicine
Background:
- Severe burn injury can alter calcium homeostasis and parathyroid hormone (PTH) levels.
- Previous studies suggest children with severe burns exhibit hypocalcemia and hypoparathyroidism, potentially due to up-regulation of the calcium-sensing receptor (CaSR).
- Adults do not consistently show this response, indicating a possible developmental difference in CaSR regulation by cytokines.
Purpose of the Study:
- To review existing literature on burn injuries to determine if pediatric and adult calcemic and PTH responses support a developmental difference in CaSR regulation.
- To investigate the clinical significance of extracellular calcium's potential role in stimulating the inflammatory response post-burn.
Main Methods:
- A systematic literature review was conducted using the National Library of Medicine database.
- Search terms included "burns," "PTH," and "ionized calcium."
- Nine relevant articles from eight medical centers were identified and analyzed, with one excluded for mixed adult and pediatric data.
Main Results:
- The review included data from 245 burn patients (178 pediatric, 67 adult).
- Pediatric patients consistently showed low serum PTH concentrations and hypocalcemia (mean ionized Ca < 1.10 mM).
- Adult burn patients had normal or low ionized calcium with secondary hyperparathyroidism, and normal or mildly elevated PTH levels.
Conclusions:
- Findings support the hypothesis of an age-related CaSR response to cytokine stimulation in burn victims.
- This difference may contribute to lower inflammation levels observed in pediatric burn patients.
- Ionized calcium and PTH levels could be potential therapeutic targets for managing inflammation in burn patients.
Objectives:
The calcemic and parathyroid hormone (PTH) responses to severe burn injury appear to differ between children and adults. In our limited studies children exhibited hypocalcemic hypoparathyroidism consistent with up-regulation of the parathyroid calcium-sensing receptor (CaSR) while adults did not, suggesting a developmental cutoff in cytokine-mediated up-regulation of the CaSR. This difference may be clinically important as published studies indicate that extracellular calcium (Ca) may stimulate the inflammatory response. The aim of this study was to examine the existing literature on burns to see if the differences between pediatric and adult calcemic and PTH responses to burn supported our findings providing stronger evidence to support this developmental difference.
Methods:
We reviewed the National Library of Medicine database using the terms burns, PTH and ionized calcium and found 9 articles from 8 different medical centers; one was eliminated due to mixing of adults and children.
Results:
There were 245 burn patients reported from the literature, 178 pediatric and 67 adults. The data are mostly consistent with our reported findings. Of the 10 pediatric patients with severe burns that we studied, mean ionized Ca concentration was below the lower limit of normal of 1.10 mM. The 67 adult burn patients reported in the literature had a mean blood ionized Ca concentration that was within the adult normal range or was lower than normal but with secondary hyperparathyroidism. Moreover, serum PTH concentrations were uniformly low in the 178 children in the burn literature but normal or mildly elevated in the 67 adults.
Conclusions:
These results support the hypothesis that the difference between pediatric and adult victims is consistent with an age-related CaSR response to cytokine stimulation and may be consistent with a lower level of inflammation in children. Ionized Ca and PTH might serve as possible therapeutic targets to lower the inflammatory response in burn victims.
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