A 9-month-old infant with acute gastroenteritis develops carpopedal spasm and laryngospasm after receiving IV fluids. Serum calcium is 6.8 mg/dL (albumin normal). Which is the most appropriate immediate management?
- A Oral calcium carbonate 50 mg/kg elemental calcium
- B Intramuscular vitamin D 600,000 IU single dose
- C IV calcium chloride 10% solution 0.2 mL/kg rapid bolus
- D IV calcium gluconate 10% solution 1 mL/kg slow push with cardiac monitoring ✓
Correct answer: D. IV calcium gluconate 10% solution 1 mL/kg slow push with cardiac monitoring
Explanation
Symptomatic hypocalcemia with tetany or laryngospasm requires immediate IV calcium gluconate 10% at 1 mL/kg (9 mg elemental calcium/mL) given slowly with cardiac monitoring to avoid bradycardia. Calcium chloride contains 3 times more elemental calcium but is irritating and reserved for central lines or cardiac arrest. Oral calcium is for asymptomatic or chronic hypocalcemia. Vitamin B is for long-term management.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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