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Severe hypercalcemia following neonatal liver transplantation
S M Bartosh1, S M Sprague, Y Nakagawa
1Department of Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, Ill, USA.
Insights
A neonate receiving a liver transplant developed severe hypercalcemia due to intraoperative calcium infusions. These infusions were given to manage citrate toxicity in a baby with liver dysfunction.
Area of Science:
- Pediatric Surgery
- Nephrology
- Critical Care Medicine
Background:
- Orthotopic liver transplantation is a complex procedure for infants with liver failure.
- Massive blood product transfusions are sometimes required during prolonged neonatal surgeries.
- Citrate toxicity can occur during massive transfusions, especially in patients with hepatic dysfunction.
Observation:
- A 3-week-old infant with liver failure underwent orthotopic liver transplant.
- The infant received massive blood products during a prolonged surgical procedure.
- Post-operatively, the infant's serum calcium level was critically high at 31.3 mg/dL.
Findings:
- The severe hypercalcemia was a direct result of intraoperative calcium infusions.
- Calcium infusions were administered to counteract citrate toxicity.
- Hepatic dysfunction in the neonate impaired citrate metabolism, exacerbating the risk.
Implications:
- This case highlights the risk of iatrogenic hypercalcemia in neonates undergoing liver transplantation.
- Careful monitoring of serum calcium levels is crucial during and after massive transfusions in infants with hepatic dysfunction.
- Management strategies for citrate toxicity in neonates require careful consideration of calcium balance.
Abstract:
A 3-week-old infant with liver failure underwent an orthotopic liver transplant. Following a prolonged second surgical procedure in which he received massive amounts of blood products, his serum calcium was 31.3. mg/dl (7.8 mmol/l). This patient represents a case of severe hypercalcemia secondary to intraoperative calcium infusions given in an effort to overcome infusion-related citrate toxicity in a neonate with hepatic dysfunction.