Calcium, phosphate, and Vitamin D abnormalities in critically ill children

Abstract

Background and Aims: Calcium, phosphate, and Vitamin D abnormalities are common in critically ill children, which may affect their outcome. However, data regarding the prevalence of these abnormalities are scarce from developing countries. This study assessed the prevalence of calcium, phosphate, and Vitamin D abnormalities in critically ill children and their association with the outcome. Materials and Methods: This was a prospective, cross-sectional study of children aged 1 month to 12 years admitted to the pediatric intensive care unit of a tertiary care public hospital. Relevant clinical information and PRISM III score were recorded, and blood sample for the estimation of serum calcium, phosphate, Vitamin D, and other relevant parameters were collected at admission. Children were followed up till final outcome. Results: A total of 135 children were included with a median age of 36 months. Total and ionized hypocalcemia were present in 9.6% and 22.9%, respectively, and both were associated with higher mortality (P = 0.006 and 0.03, respectively). Children with total hypocalcemia more often had sepsis and required significantly more fluid boluses and inotropes. Hypophosphatemia and hyperphosphatemia were present in 28.8% and 10.3%, respectively, and were also associated with significantly higher mortality. 85.6% of the children were Vitamin D deficient, but no significant association with severity and outcome was found. Conclusion: Calcium, phosphate, and Vitamin D abnormalities were common in critically ill children. Higher mortality was associated with hypocalcemia and abnormal phosphate levels but not with Vitamin D deficiency. There was significant association of hypocalcemia with sepsis, fluid bolus, and inotrope requirement.