Calcemic response to burns differs between adults and children: A review of the literature

Model System:

Burn

Reference Type:

Journal article

Accession No.:

J81097

Journal:

Osteoporosis and Sarcopenia

Year, Volume, Issue, Page(s):

2017 , 3, 4, 170-173

Publication Website:

Abstract:

Study examined the existing literature on burns to see if the differences between pediatric and adult calcemic and parathyroid hormone (PTH) responses to burn injury. The authors’ research has shown that children present with sustained hypocalcemia, hypomagnesemia, and hypoparathyroidism consistent with up-regulation of the parathyroid calcium-sensing receptor (CaSR) while adults did not, suggesting that cytokine-mediated up-regulation of the CaSR is age-related. This difference may be clinically important as published studies indicate that extracellular calcium (Ca) may stimulate the inflammatory response. The National Library of Medicine database was reviewed using the terms burns, PTH, and ionized calcium and identified 9 articles from 8 different medical centers; one was eliminated due to mixing of adults and children. There were 245 burn patients reported from the literature: 178 pediatric and 67 adults. The data are mostly consistent with our reported findings. Of the 10 pediatric patients with severe burns that we studied, mean ionized Ca concentration was below the lower limit of normal of 1.10 mM. The 67 adult burn patients had a mean blood ionized Ca concentration that was within the adult normal range or was lower than normal but with secondary hyperparathyroidism. Moreover, serum PTH concentrations were uniformly low in the 178 children in the burn literature but normal or mildly elevated in the 67 adults. These results support the hypothesis that the difference between pediatric and adult victims is consistent with an age-related CaSR response to cytokine stimulation and may be consistent with a lower level of inflammation in children. Ionized Ca and PTH might serve as possible therapeutic targets to lower the inflammatory response in burn victims.

Author(s):

Klein, Gordon L.|Benjamin, Debra A.|Herndon, David N.|