Calcium in preemies

[AngelaCondie]

In preemies, do you start calcium in the IV right away? How much? Do you have a problem with calcium infiltration of the skin? We have used D10 for the first day, then switch to D1/5. If they are still not tolerating feeds by the third day, we add KCl. When should we add calcium? Should we use D1/2 instead? Thanks

[Mohan]

On 1/12/2016 at 6:18 AM, AngelaCondie said:

In preemies, do you start calcium in the IV right away? How much? Do you have a problem with calcium infiltration of the skin? We have used D10 for the first day, then switch to D1/5. If they are still not tolerating feeds by the third day, we add KCl. When should we add calcium? Should we use D1/2 instead? Thanks

 

[yalsaba]

Start Calcium in the first day but only in central line. Calcium should not be given through peripheral line..

[Stefan Johansson]

Hi @AngelaCondie - we always consider the risk of hypocalcemia as well and always follow s_ca (we get this on our blood gases). Unless the baby is "near-term" (say 33-36 weeks, and we aim for enteral feeding only), we use our "standard-TPN"-bags. The calcium content typically gives 0.5 mmol/kg the first day and we soon reaches 1 mmol/kg/d which we aim for as the normal amount. If needed we also add ~0.5 mmol Ca/kg/d, in a central line.

 

[Stefan Johansson]

I add some more input here:

We may consider peripher veins too but then always together with the regular fluid (usually glucose).

The tricky question is when calcium is really-really needed… I am not sure it is always needed when we give it. Typically we treat a lab value. Here we let S-ca (free) go below 1.0 mmol/L before we do anything if the baby is reasonable well.

Further, the calcium ions move in/out cells depending on pH, so for example, if a baby is instable with breathing /resp support, calcium can change up/down without us knowing more than the glimpse we get when we take the sample.