Neonatal Conference - Brandau Flashcards
9 day old hispanic M
-seizures and apnea
stiffening of body and laryngospasm
STAT lab test?
hypocalcemia on labs
history - no prenatal vits and supps
PE - no dysmorphic features
DDx - electrolyte abnormality - feeding issue
- also sepsis meningitis
- metabolic disorder
dextrose stick - check for hypoglycemia**
check airway
when find hypocalcemia - infuse calcium
-careful with IV Ca - not infiltrating skin - toxic and necrosis bad
diagnosis -transient hypoparathyroidism - low Ca and elevated P**
-normal PTH confirmed diagnosis
supplement needed for breast fed term infant
vitamin D**
folic acid deficiency
neural tube defect
with low Ca
consider Vit D supplement
craniotabes
demineralization of bone
with low Ca - body wants to rise - breaks down bone
chvostek sign
indicator of hypocalcemia
facial tap twitching
calcium levels
very variable levels
-preterm may see very low Ca
PTH gland development is varied
DDx of neonatal hypocalcemia
maternal diabetes birth asphyxia sepsis - macrophage generate cytokines affect PTH preterm birth increased calcitonin resistance to PTH decreased PTH secretion
transient hypoparathyroidism
variable causes
offspring of mother with hyperparathyroid or hypercalcemia**
less mature infant
more subtle the findings
hypocalcemia signs
jittery convulsions seizures lethargy poor feeding abdominal distention
CXR with hypocalcemia
to rule out CATCH-22 - 22q11.2 deletion
thymic shadow and aortic arch position
Vit D pathway
liver > kidney > GI
increases serum calcium
stage 1 rickets
deficiency in D3 - decreased Ca absorption
increased PTH**
stage 2 rickets
P decreases over time
decreased amouth of 25-D and no conversion to 1,25-D
