TY - JOUR
T1 - Dysregulation of calcium homeostasis after severe burn injury in children
T2 - Possible role of magnesium depletion
AU - Klein, G. L.
AU - Nicolai, M.
AU - Langman, C. B.
AU - Cuneo, B. F.
AU - Sailer, D. E.
AU - Herndon, D. N.
N1 - Funding Information:
Supported in part by grants from Shriners Hospitals for Crippled Children No. 8870 (G.L.K.) and National Institutes of Health grant No. RR00048 (C.B.L.), and Children’s Memorial Institute for Education and Research (C.B.L.).
PY - 1997
Y1 - 1997
N2 - Objective: To determine the cause and extent of hypocalcemia observed in children after severe burns. Design: We studied 10 children with burns covering 57% ± 17% (SD) body surface area, ages 9.6 ± 4.7 years, who were admitted consecutively during a 6-month period. Diet supplied a minimum of 2.7 gm/m2 of calcium, 0.3 gm/m2 of magnesium, and 2.2 gm/m2 phosphate. Blood specimens were obtained daily for 10 ± 5 days for the following tests: (1) simultaneous analysis for ionized calcium, magnesium, and intact parathyroid hormone (group A); (2) two of these children, randomly selected, had serial 2-hour determinations on a single day (group B); (3) a modified Ellsworth-Howard test, consisting of a 10-minute infusion of synthetic parathyroid hormone 18 ± 10 days postburn and associated changes in urinary cyclic adenosine monophosphate excretion and renal threshold phosphate concentration (group C). Three of these children, when normomagnesemic, also received a standard magnesium infusion to determine magnesium retention (group D). Data were analyzed with chi-square, regression analysis, and nonparametric testing as appropriate. Results: All patients showed sustained hypocalcemia and hypomagnesemia; intact parathyroid hormone response was inappropriately low and response to synthetic parathyroid hormone infusion was blunted. Lowest ionized calcium levels were associated with hypomagnesemia. Conclusion: Hypoparathyroidism and blunted renal response to parathyroid hormone suggest that magnesium depletion may contribute to their pathogenesis. Magnesium repletion and monitoring are recommended.
AB - Objective: To determine the cause and extent of hypocalcemia observed in children after severe burns. Design: We studied 10 children with burns covering 57% ± 17% (SD) body surface area, ages 9.6 ± 4.7 years, who were admitted consecutively during a 6-month period. Diet supplied a minimum of 2.7 gm/m2 of calcium, 0.3 gm/m2 of magnesium, and 2.2 gm/m2 phosphate. Blood specimens were obtained daily for 10 ± 5 days for the following tests: (1) simultaneous analysis for ionized calcium, magnesium, and intact parathyroid hormone (group A); (2) two of these children, randomly selected, had serial 2-hour determinations on a single day (group B); (3) a modified Ellsworth-Howard test, consisting of a 10-minute infusion of synthetic parathyroid hormone 18 ± 10 days postburn and associated changes in urinary cyclic adenosine monophosphate excretion and renal threshold phosphate concentration (group C). Three of these children, when normomagnesemic, also received a standard magnesium infusion to determine magnesium retention (group D). Data were analyzed with chi-square, regression analysis, and nonparametric testing as appropriate. Results: All patients showed sustained hypocalcemia and hypomagnesemia; intact parathyroid hormone response was inappropriately low and response to synthetic parathyroid hormone infusion was blunted. Lowest ionized calcium levels were associated with hypomagnesemia. Conclusion: Hypoparathyroidism and blunted renal response to parathyroid hormone suggest that magnesium depletion may contribute to their pathogenesis. Magnesium repletion and monitoring are recommended.
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U2 - 10.1016/S0022-3476(97)70161-6
DO - 10.1016/S0022-3476(97)70161-6
M3 - Article
C2 - 9290611
AN - SCOPUS:0030657410
SN - 0022-3476
VL - 131
SP - 246
EP - 251
JO - Journal of Pediatrics
JF - Journal of Pediatrics
IS - 2
ER -