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Hypocalcemia and hyperphosphatemia in severely dehydrated children with and without convulsions
A Murtaza1, S R Khan, K S Butt
1Department of Paediatrics, King Edward Medical College, Lahore, Pakistan.
Insights
Severely dehydrated children often develop hypocalcemia (low calcium) and hyperphosphatemia (high phosphorus). Rehydration therapy normalized these levels, suggesting ion shifts contribute to convulsions in dehydration.
Area of Science:
- Pediatrics
- Biochemistry
- Clinical Medicine
Background:
- Tetanic convulsions are frequent in dehydrated children in developing nations.
- This suggests potential disturbances in divalent ion homeostasis.
Purpose of the Study:
- To investigate serum levels of calcium, magnesium, phosphorus, sodium, and potassium, as well as blood pH.
- To assess these parameters in children under 3 years with acute watery diarrhea and significant dehydration.
Main Methods:
- Studied dehydrated children with (DC) and without (D) convulsions.
- Measured serum electrolytes and blood pH on admission and after rehydration therapy (RT).
Main Results:
- On admission, both D and DC groups showed low serum calcium and elevated phosphorus.
- Serum magnesium was slightly elevated in DC children.
- RT significantly increased serum calcium and decreased serum phosphorus in both groups.
Conclusions:
- Severely dehydrated children commonly develop hypocalcemia.
- Ion redistribution, particularly calcium into cells and phosphorus into the extracellular space, may cause these imbalances and convulsions.
Abstract:
Tetanic convulsions are not uncommon among severely dehydrated children in the developing countries. This raises the question whether these children have disturbances in the homeostasis of divalent ions. Serum values are reported of calcium, magnesium, phosphorus, sodium and potassium, as well as blood pH in children below 3 years of age with acute watery diarrhoea and with an estimated weight loss of about 10%. The study was performed on dehydrated children with (DC) or without (D) convulsions. Values were obtained on admission and following rehydration therapy (RT). On admission serum calcium was low in both D and DC children. Serum phosphorus was likewise elevated in both D and DC children. Serum magnesium was slightly elevated in the DC but not in the D group. No patient had hypernatremia. During RT, serum calcium increased significantly and serum phosphorus decreased significantly in D and DC children. Serum calcium showed a significant inverse correlation with serum phosphorus and a significant direct correlation with blood pH. Treatment of DC children with i.v. calcium and i.m. magnesium had no immediate effect on the convulsions. Our conclusion is that severely dehydrated children will develop hypocalcemia. The cause may be a redistribution of calcium into the cells, parallelled by a redistribution of phosphorus from the intra- to the extracellular space.