An 8-hour-old, 1600-gram neonate shows twitching movements and signs consistent with hypocalcemia. The most appropriate course of action is to administer which of the following?

An 8-hour-old, 1600-gram neonate shows twitching movements and signs consistent with hypocalcemia. The most appropriate course of action is to administer which of the following?

• A. Administer calcium gluconate 250 mg (2.5 mL of 10% solution)
• B. Glucose 10 mg IV over 5 minutes (2 mL of D5W)
• C. Hyperventilate with 100% O2
• D. Administer a 20-mL bolus of 5% albumin

Answer: (A)

When a neonate shows twitching and symptoms of hypocalcemia, the priority is to rapidly raise the serum calcium to suppress neuromuscular irritability. Administering calcium gluconate intravenously provides a fast and effective correction of the calcium deficit. The dose shown (250 mg of a 10% calcium gluconate solution, given as 2.5 mL) is a typical rapid-load amount for a small prematurity like this infant and will quickly increase ionized calcium, relieving the tetany and seizure-like activity. The other options don’t address the underlying low calcium. Glucose would treat hypoglycemia if present, not hypocalcemia. Hyperventilating can induce respiratory alkalosis, which lowers ionized calcium and can worsen symptoms. A 20 mL albumin bolus would not correct acute hypocalcemia and is not indicated here.

When a neonate shows twitching and symptoms of hypocalcemia, the priority is to rapidly raise the serum calcium to suppress neuromuscular irritability. Administering calcium gluconate intravenously provides a fast and effective correction of the calcium deficit. The dose shown (250 mg of a 10% calcium gluconate solution, given as 2.5 mL) is a typical rapid-load amount for a small prematurity like this infant and will quickly increase ionized calcium, relieving the tetany and seizure-like activity.

The other options don’t address the underlying low calcium. Glucose would treat hypoglycemia if present, not hypocalcemia. Hyperventilating can induce respiratory alkalosis, which lowers ionized calcium and can worsen symptoms. A 20 mL albumin bolus would not correct acute hypocalcemia and is not indicated here.