Abstract
A seven-day-old male neonate presented with symptomatic hypocalcemia in the form of generalized seizure activity for three minutes. He arrived at the pediatric emergency department in a postictal state. His clinical examination was unremarkable, but his initial laboratory evaluation revealed marked hypocalcemia and hypomagnesemia. The patient received intravenous boluses of calcium gluconate for correction. The patient had bradycardia during the first calcium gluconate infusion, and on the second infusion, he developed frequent premature ventricular contractions, which progressed into polymorphic ventricular tachycardia. Arrhythmia reverted to sinus rhythm after discontinuation of the calcium gluconate infusion without the need for chemical/electrical cardioversion. Subsequently, two extra doses of intravenous calcium gluconate for persistent hypocalcemia were administered safely. The patient was discharged home successfully in a good general condition after stabilization. The emergence of bradycardia during calcium gluconate infusion should be considered a red flag since it can trigger serious cardiac arrhythmia, especially in the presence of electrolyte abnormalities such as hypocalcemia and hypomagnesemia. We report this case to stress the need for continuous cardiac monitoring of children on calcium gluconate infusion even if proper dose, dilution, and rate of infusion are used, as serious cardiac arrhythmia can be unpredictable and may develop at any time.
Highlights
Hypocalcemia is not an uncommon disorder in the neonatal period, and can be a life-threating emergency.[1,2,3] Treatment of symptomatic hypocalcemia using intravenous calcium infusion is a common practice.[4]
We report a case with polymorphic ventricular tachycardia (VT) that developed during the second dose of intravenous calcium gluconate administration for the treatment of symptomatic neonatal hypocalcemia that reverted after calcium gluconate infusion discontinuation
CASE PRESENTATION A previously healthy seven-day-old boy presented to the emergency department (ED) with a history of generalized tonic-clonic convulsions lasting for three minutes, which aborted spontaneously prior to arrival
Summary
Hypocalcemia is not an uncommon disorder in the neonatal period, and can be a life-threating emergency.[1,2,3] Treatment of symptomatic hypocalcemia using intravenous calcium infusion is a common practice.[4]. Twelve hours after the first calcium gluconate infusion, serum calcium was still low (ionized calcium 0.75 mmol/L), and the patient was still having brief episodes of tonic-clonic convulsions that required two more doses (200 mg/kg/dose) of intravenous calcium gluconate diluted 1:10 to a concentration of 10 mg/mL with 0.9% saline, which were administered safely. Both doses were given over a one-hour period
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