sử dụng thuốc lợi tiểu thẩm thấu, và hypernatremia cần thiết vẫn còn trong sự khác biệt giữa các. Đây là những hiếm ở trẻ sơ sinh và sẽ tiếp tục nhiệm vụ workup điều trị phản ánh điều kiện cơ bản. Hypocalcemia khẩn cấp bộ phận trình bày Hypocalcemia là một trong những bất thường điện giải phổ biến nhất gặp phải trong giai đoạn sơ sinh | 870 CLAUDIUS et al without stigmata or findings of dehydration hyperaldosteronsim obstructive uropathy osmotic diuretic use and essential hypernatremia remain in the differential. These are rare in infants and will mandate further workup with treatment reflective of the underlying condition. Hypocalcemia Emergency department presentation Hypocalcemia is one of the most common electrolyte abnormalities encountered in the newborn period and often presents with jitteriness or seizures. It is important for the ED physician to recognize hypocalcemia as a cause of newborn seizures as patients are frequently treated without assessment of serum calcium 71 . Other symptoms of hypocalcemia may include lethargy poor feeding irritability and vomiting. As with adult patients the QT interval on ECG may be increased and infants are at risk for myocardial depression and sudden cardiac death. Unlike older patients Chvostek and Trousseau signs will likely not be present in this age group 72 . Hypocalcemia is defined as a level 6 mg dL in preterm newborn 7 mg dL in a term newborn and 8 mg dL in a term infant over 1 week of age 73 and is divided into early-onset hypocalcemia delayed hypocalcemia and childhood hypocalcemia thereafter 73 . Differential diagnosis All infants have a slight decline in serum calcium levels just after birth with the nadir at approximately 24 to 48 hours of age. Generally this is asymptomatic and resolves without therapy by the fifth day of life. Symptomatic hypocalcemia is much more common in infants of diabetic mothers preterm infants and infants with a history of anoxic encephalopathy and may be an exaggeration of the normal fall in serum calcium after birth 72 74 . With the trend toward 24- and 48-hour newborn discharge ED physicians may see more of this early neonatal population. Up to 80 of infants with symptomatic early neonatal hypocalcemia have concomitant hypomagnesemia and will not respond to calcium therapy without correction of the hypomagnesemia
