Sanchez G J, Venkataraman P S, Pryor R W, Parker M K, Fry H D, Blick K E
Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City 73190.
J Pediatr. 1989 Jun;114(6):952-6. doi: 10.1016/s0022-3476(89)80436-6.
We studied the hypotheses that serum calcium and blood ionized calcium would be low in acutely ill children and would rise with clinical improvement. In 15 children admitted to the pediatric intensive care unit, the blood ionized calcium level was 4.45 +/- 0.06 mg/dl (1.11 +/- 0.015 mmol/L) on entry versus 5.17 +/- 0.03 mg/dl (1.29 +/- 0.01 mmol/L) in control subjects (p less than 0.005), rose significantly on days 2 and 3, and was 5.12 +/- 0.04 mg/dl (1.28 +/- 0.01 mmol/L) at discharge (p less than 0.005). Changes in serum calcium level were similar, whereas serum magnesium and phosphorus levels were normal and did not change. Basal serum parathyroid hormone concentrations were elevated, rose further during the study, and were normal at discharge. Serum parathyroid hormone levels correlated inversely with blood ionized calcium levels, indicating that compensatory hyperparathyroidism occurs with low blood ionized calcium concentrations. Basal serum calcitonin values were evaluated on entry and decreased with clinical improvement. Serum calcitonin levels correlated significantly with low blood ionized calcium levels, indicating that hypercalcitoninemia may play a role in the pathogenesis of hypocalcemia in these children. Urine calcium excretion was not increased in the four children studied. We speculate that with clinical improvement, a rise in serum parathyroid hormone levels and a decline in serum calcitonin levels may help restore normocalcemia in these acutely ill children.
急性病患儿的血清钙和血离子钙会降低，并会随着临床症状的改善而升高。在15名入住儿科重症监护病房的患儿中，入院时血离子钙水平为4.45±0.06mg/dl（1.11±0.015mmol/L），而对照组为5.17±0.03mg/dl（1.29±0.01mmol/L）（p<0.005），在第2天和第3天显著升高，出院时为5.12±0.04mg/dl（1.28±0.01mmol/L）（p<0.005）。血清钙水平的变化类似，而血清镁和磷水平正常且未发生变化。基础血清甲状旁腺激素浓度升高，在研究期间进一步上升，出院时恢复正常。血清甲状旁腺激素水平与血离子钙水平呈负相关，表明低血离子钙浓度时会发生代偿性甲状旁腺功能亢进。入院时评估基础血清降钙素值，其随临床症状改善而降低。血清降钙素水平与低血离子钙水平显著相关，表明高降钙素血症可能在这些患儿低钙血症的发病机制中起作用。所研究的4名患儿尿钙排泄未增加。我们推测，随着临床症状的改善，血清甲状旁腺激素水平的升高和血清降钙素水平的降低可能有助于这些急性病患儿恢复正常血钙水平。
