Dysregulation of calcium homeostasis after severe burn injury in children: Possible role of magnesium depletion

G. L. Klein; M. Nicolai; C. B. Langman; B. F. Cuneo; D. E. Sailer; D. N. Herndon

doi:10.1016/S0022-3476(97)70161-6

Dysregulation of calcium homeostasis after severe burn injury in children: Possible role of magnesium depletion

G. L. Klein^*, M. Nicolai, C. B. Langman, B. F. Cuneo, D. E. Sailer, D. N. Herndon

^*Corresponding author for this work

Pediatrics

Research output: Contribution to journal › Article › peer-review

88 Scopus citations

Abstract

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.

Original language	English (US)
Pages (from-to)	246-251
Number of pages	6
Journal	Journal of Pediatrics
Volume	131
Issue number	2
DOIs	https://doi.org/10.1016/S0022-3476(97)70161-6
State	Published - 1997

Funding

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.).

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health

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10.1016/S0022-3476(97)70161-6

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@article{98cc8426f947463884efa59cc1c3ccb7,

title = "Dysregulation of calcium homeostasis after severe burn injury in children: Possible role of magnesium depletion",

abstract = "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.",

author = "Klein, {G. L.} and M. Nicolai and Langman, {C. B.} and Cuneo, {B. F.} and Sailer, {D. E.} and Herndon, {D. N.}",

note = "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{\textquoteright}s Memorial Institute for Education and Research (C.B.L.). ",

year = "1997",

doi = "10.1016/S0022-3476(97)70161-6",

language = "English (US)",

volume = "131",

pages = "246--251",

journal = "Journal of Pediatrics",

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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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Dysregulation of calcium homeostasis after severe burn injury in children: Possible role of magnesium depletion

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