Severe hypocalcemia and seizures after normalization of pCO2 in a patient with severe bronchopulmonary dysplasia and permissive hypercapnia

IF 0.1 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Perinatal Medicine Pub Date : 2021-01-01 DOI:10.1515/crpm-2021-0039

Erick J. Bordón Sardiña, Cristina Romero Álvarez, Rocío Díaz de Bethencourt Pardo, L. Urquía Martí, F. García-Muñoz Rodrigo

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引用次数: 1

Abstract

Abstract Objectives To describe the association between the rapid normalization of pCO2 after intubation in a patient with severe bronchopulmonary dysplasia managed with permissive hypercapnia, with the risk of developing hypocalcemia and seizures, and to make health care providers aware of this risk in similar cases. Case presentation An extreme premature infant, born at 25 weeks of gestational age (GA), developed a severe bronchopulmonary dysplasia (BPD) and, after several extubation failures could be managed with non-invasive ventilation and permissive hypercapnia, with capillary pCO2 of up to 80 mmHg and pH >7.20. At 46 postmenstrual age (PMA) he was intubated because of severe hypercapnia and compensating metabolic alkalosis. About 20 h after intubation, after normalization of pH and pCO2, he developed hypocalcemia and seizures, that remitted after iCa normalization. A comparison between arterial and capillary blood gases showed a significantly greater correlation between pH and iCa in arterial than in capillary samples. Conclusions Our findings emphasize the importance of avoiding the abrupt reduction of pCO2 and the close monitoring of acute metabolic changes after its correction in chronic patients with permissive hypercapnia, as well as the potential superiority of arterial samples over capillaries to improve the precision of this control.

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严重支气管肺发育不良伴容许性高碳酸血症患者pCO2正常化后的严重低钙血症和癫痫发作

【摘要】目的探讨重度支气管肺发育不良伴允许性高碳酸血症患者插管后pCO2快速正常化与发生低钙血症和癫痫发作的风险之间的关系，并使卫生保健提供者意识到类似病例的这种风险。一例极端早产儿，出生在25周孕龄(GA)，发展为严重的支气管肺发育不良(BPD)，在几次拔管失败后，可以通过无创通气和允许性高碳酸血症进行治疗，毛细血管二氧化碳分压高达80mmhg, pH值为7.20。46岁经后年龄(PMA)，因严重高碳酸血症和代谢性碱中毒插管。插管后约20 h, pH和pCO2恢复正常后，患者出现低钙血症和癫痫发作，iCa恢复正常后症状缓解。动脉血气和毛细血管血气的比较表明，动脉血气中pH值和iCa的相关性明显高于毛细血管样本。结论我们的研究结果强调了避免pCO2突然降低和密切监测慢性允许性高碳酸血症患者纠正后的急性代谢变化的重要性，以及动脉样本相对于毛细血管样本的潜在优势，以提高这种控制的准确性。

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来源期刊

Case Reports in Perinatal Medicine OBSTETRICS & GYNECOLOGY-

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期刊介绍： Case Reports in Perinatal Medicine is a double-blind peer-reviewed journal. The objective of the new journal is very similar to that of JPM. In addition to evidence-based studies, practitioners in clinical practice esteem especially exemplary reports of cases that reveal specific manifestations of diseases, its progress or its treatment. We consider case reports and series to be brief reports describing an isolated clinical case or a small number of cases. They may describe new or uncommon diagnoses, unusual outcomes or prognosis, new or infrequently used therapies and side effects of therapy not usually discovered in clinical trials. They represent the basic concept of experiences for studies on representative groups for further evidence-based research. The potential roles of case reports and case series are: Recognition and description of new diseases Detection of drug side effects (adverse or beneficial) Study of mechanisms of disease Medical education and audit Recognition of rare manifestations of disease.