Elsevier

Journal of Critical Care

Volume 28, Issue 5, October 2013, Pages 810-815
Journal of Critical Care

Clinical Potpourri
Ionized hypocalcemia is an early event and is associated with organ dysfunction in children admitted to the intensive care unit

https://doi.org/10.1016/j.jcrc.2013.03.019Get rights and content

Abstract

Purpose

The purpose was to determine the frequency and risk factors of ionized hypocalcemia and to evaluate this disturbance as a predictor of mortality in a pediatric intensive care unit (ICU).

Materials and Methods

In a prospective cohort study, 337 children admitted consecutively to an ICU were monitored regarding serum ionized calcium concentrations during the first 10 days of admission. The following variables were analyzed as independent of hypocalcemia: age; malnutrition; sepsis; Pediatric Index of Mortality 2; first 3 days organ dysfunction score (Pediatric Logistic Organ Dysfunction); and use of steroids, furosemide, and anticonvulsants. Hypocalcemia was defined as a serum ionized calcium concentration less than 1.15 mmol/L.

Results

The rate of hypocalcemia was 77.15%. In a multivariate model, higher Pediatric Logistic Organ Dysfunction scores during the first 3 days of ICU stay were independently associated with hypocalcemia (odds ratio, 2.24; 95% confidence interval, 1.23-4.07; P = .008). Medications associated with hypocalcemia were furosemide (dose ≥ 2 mg/[kg d]) and methylprednisolone (dose ≥ 2 mg/[kg d]). No significant association was found between hypocalcemia and 10-day mortality.

Conclusions

Ionized hypocalcemia is common during the ICU stay, particularly in the first 3 days of admission. This disturbance was not found to be a predictor of mortality, but it is independently associated with more severe organ dysfunction.

Section snippets

Methods

A prospective cohort study of children admitted consecutively to the pediatric ICU of a teaching hospital was carried out in which serum calcium concentrations were monitored during the first 10 days of the hospital stay. All patients with a previous diagnosis of chronic renal failure, hypoparathyroidism, or brain death and those lacking data on ionized calcium levels were excluded from the study. The study site was a high-complexity unit, classed as Level 1 A according to the guidelines of the

Results

Of a total of 475 children admitted to the ICU between January 2006 and January 2008, 27 patients were excluded because of chronic renal disease, 6 because of brain death on admission, and 105 because of lack of ionized calcium data (only total calcium available) for the first 3 days of the hospital stay, giving a final sample of 337 patients. Patients had been referred from the surgical ward (42.9%), emergency department (23%), and semi-ICU (12.8%). The main characteristics of the patients are

Discussion

Hypocalcemia was common in the ICU, occurring in 77.15% of patients during the study period. This result is consistent with the findings of other studies in the literature showing a hypocalcemia frequency of between 18% and 74% among ICU patients [10], [11], [12]. However, in the cited reports, hypocalcemia was determined based on either total or ionized calcium concentrations. In the present study, the diagnosis of hypocalcemia was reached based only on ionized calcium because this represents

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