Hypocalcaemia in Children

Description

Diagnostic criteria

Medicine treatment

Referral

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ICD-10 Code: E83.5

DESCRIPTION

The main causes of hypocalcaemia in children are:

• vitamin D deficiency,
• calcium deficiency,
• magnesium deficiency,
• reduced parathyroid hormone production or resistance,
• impaired renal function, and
• hyperventilation. 

DIAGNOSTIC CRITERIA

Clinical

• Signs and symptoms of tetany include:
  • paraesthesia,
  • positive Chvostek’s sign,
  • cramps,
  • positive Trousseau’s sign,
  • carpopedal spasm,
  • weakness,
  • laryngospasm,
  • lethargy,
  • prolonged QT interval on the ECG.

Investigations

• Blood level to establish cause:
  • calcium,
  • albumin,
  • phosphate,
  • magnesium,
  • ALP,
  • 25-Hydroxyvitamin D.

MEDICINE TREATMENT

Acute hypocalcaemia

• Calcium gluconate 10%, IV, 1–2 mL/kg administered over 5–10 minutes, 6–8 hourly.
  • Maximum dose: 10 mL.
  • ECG monitoring is advised.

If hypomagnesaemic:

• Magnesium sulphate 50%, IV/IM, 0.2 mL/kg every 12–24 hours.

Chronic therapy
Long-term therapy depends on the cause.
Manage hypophosphataemia or hyperphosphatemia, depending on the cause of hypocalcaemia, before long-term calcium is initiated.

• Calcium, elemental, oral, 45-65 mg/kg/day until normal calcium level is achieved (given with meals).
  • Maintenance dose: 30 mg/kg/day.

If vitamin D deficient:  

• Vitamin D, oral:
  • Under 6 months: 2500 IU/day
  • 6 months - 12 years: 5000 IU/day
  • 12 - 18 months: 10 000 IU/day

For hypoparathyroidism and pseudohypoparathyroidism:

• Calcitriol, oral, 0.01–0.04 μg/kg/day.

OR

• Alfacalcidol, oral, 0.05 μg/kg/day.
  • If < 20 kg: 0.05 μg/kg/day.
  • If > 20kg: 1 μg/day.

REFERRAL

• Chronic hypocalcaemia. 

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition

Chapter 7: Endocrine, 7.8 Hypocalcaemia In Children