Abstract
We measured the maximum increase and rate of decrease in serum calcium and ionized calcium concentrations following a rapid infusion of 18 mg/kg of elemental calcium in 24 hypocalcemic premature neonates. The peak increases were estimated to be 6.10 and 2.55 mg/dl above baseline for calcium and ionized calcium, respectively. Decreases in both calcium and ionized calcium concentrations toward baseline were linear functions of the log of the time in minutes since the infusion. By approximately 30 minutes after the infusion, the increase in concentration was half of the estimated peak increase; the estimated time to return to baseline was 12 hours for serum calcium concentrations and 15 hours for serum ionized calcium. The rapid decrease in serum concentrations was probably related to skeletal accumulation and could not be accounted for by renal loss since only a mean of 1.5% of the infused calcium was estimated to have been lost in the urine. From these data we suggest that bolus calcium therapy may not be the most effective way to treat neonatal hypocalcemia if the sustained increase in the serum calcium concentration is the primary goal of therapy.
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