Early Hypocalcemia: 2-3 days

• Prematurity
– 1/3 of premature infants, majority VLBW infants
– Hypoalbuminemia, impaired PTH, low vit D
• IUGR
– Decrease Ca across the placenta
• Birth asphyxia
– Hyperphosphatemia
– Renal insufficiency, acidosis
• Infants of Diabetic Mothers
– 10-50%
– Lower levels of PTH
Late hypocalcemia: after 2-3
DOL
• Hypoparathyroidism *most common*
– Associated excess phosphorus intake
• DiGeorge- 22q11
– Neural crest cells fail to migrate
– Midline defects
• Hypomagnesemia
– Causes resistance to PTH, impairs PTH secretion
– Intestinal or renal transport problems
• Maternal hyperparathyroidism
• Acute renal failure
• Any disorder of vitamin D metabolism
Hypocalcemia in children
• Loss of calcium
– Hyperphosphatemia
– Alkalosis
– Intravascular complexing with citrate, lactate
– Acute pancreatits
• Hypoparathyroidism
– Impaired synthesis or secretion
• Genetic
• Autoimmune
• Thyroid or Parathyroid surgery
 Hypocalcemia in children
• Hypovitaminosis D
– Vitamin D resistance
– Impaired synthesis or intake
• Insufficient dietary intake and/or sun exposure
• Decreased GI absorption
• Liver disease
• Renal Disease
• Hypomagnesemia
• Misc
– Fluoride poisoning