Page 205 - Abstract Book KONIKA 18

Endocrinology

P-ENDO-057
Late Onset Neonatal Hypocalcemia in 20-day-old Baby: A Case Report

Harjoedi Adji Tjahyono, Irfan Agus Salim
Departement of Child Health, Faculty of Medicine Universitas Brawijaya/Saiful Anwar General Hospital,
Malang, East Java, Indonesia
Abstract
Background Neonatal hypocalcemia is a common metabolic problem in newborn period and infancy.
Neonatal hypocalcemia are affect to the cardiac system as disturbance contractility of heart pump and
affect the repolarization of the heart muscle fibers, and also can affect the CNS system and neuromuscular
function. Manifestation in CNS system like “Jitteriness”, general hyperreactivity, and “jumpiness”, are
classically reported in hypocalemic neonates. Case We report a case of late onset neonatal hypocalcemia
in twenty-days-old baby. He was born on 38-39 week of gestational age by caesarean section, without
asphyxia nor neonatal infection. The baby had refractory general seizure one until two minute each seizure,
there is no history of fever, diarrhea and vomiting before the onset of seizure. He has low serum calcium
refractories. The patient with vitamin D defficiency 11,23 ng/mL. He has increase of ALP level and normal
parathyroid hormone. And, he has a low level of FT4 and high level of TSH. Our patient was given vitamin
D therapy and there was an improvement in calcium levels after that. Discussion Neonatal hypocalcemia
can be a potentially life-threatening condition, but the clinical signs are often asymptomatic. Hypocalcemia
is defined as total serum calcium <8mg/dL (2 mmol/L) or ionized calcium <4.4 mg/dL (1.1 mmol/L) for
term infants or preterm infants weighing >1500 gr at birth and total serum calcium <7 mg/dL (1.75 mmol/L)
or ionized calcium <4 mg/dL (1 mmol/L) for very low bith weight infants weighing <1500 gr. Early onset
hypocalcemia is generally asymptomatic; therefore screening for hypocalcemia at 24 dan 48 hour after
th
th
birth is warranted for infants with high risk of developing hypocalcemia. Late onset hypocalcemia which is
generally symptomatic, develop after the first 72 hour and toward the end of the first week of life. Excessive
phosphate intake , hypomagnesemia, hypoparathyroidism, and vitamin D deficiency are commonest causes
of late onset hypocalcemia. Elementary calcium of 10 to 20 mg/kg (1-2 mL/kg/dose 10% calcium gluconate)
is given as a slow intravenous infusion in the acute treatment of hypocalcemia in patients with symptoms
of tetany or hypocalcemic convulsion. Conclusion Since most infants with hypocalcemia are usually
asymptomatic , serum total or ionized calcium levels must be monitored in preterm infants with a gestational
age <32 weeks, small for gestational age infants, infants of diabetic mothers and infant with severe prenatal
asphyxia with a 1 minute Apgar score of <4. The treatment of hypocalcemia should be initiated immediately
in infants with reduced calcium levels while investigating the etiology
Keywords: neonatal hypocalcemia; vitamin D deficiency; parathyroid hormone

P-ENDO-058
A Rare Case of Neonatal Diabetes Mellitus in 11-month-old Baby Boy
in Saiful Anwar Hospital Malang

Hanna Tetty Irfan Agus Salim, Harjoedi Adji Tjahjono
Pediatric Department, Faculty of Medicine, Universitas Brawijaya, Malang, East Java, Indonesia

Abstract
Background Neonatal diabetes mellitus, defined as insulin-requiring hyperglycemia within the first month
of life, is a rare disorder that is usually associated with intrauterine growth retardation. Neonatal diabetes is
heterogenous and can be either transient or permanent. The clinical signs include dehydration, hyperglycemia,
and mild or no ketonemia/ketonuria. Objective To report a case of a neonatal diabetes mellitus in an-eleven-
months-old baby. Case We report a case of a neonatal diabetes mellitus in an-eleven-months-old baby, born
by caesarean section, with asphyxia neonatal. The baby had refractory vomiting over 3 times in a day, ±60
cc each vomit, containing milk which he took. There is a history of diarrhea, no history of fever. His blood
glucose is 219 mg/dL, his HbA1c is 6% and his keton is 3,6 mmol/L. Conclusion Correctly identifying
monogenic NDM has important implications for appropriate treatment, expected disease course and associated
conditions, and genetic testing for at risk family members. Early recognition of monogenic NDM allows the
implementation of appropriate therapy, leading to improved outcomes and potential societal cost savings
Keywords: neonatal diabetes mellitus; hyperglycemia

KONIKA XVIII Abstract Book 157