Persistent hypoparathyroidism following magnesium repletion in burn-injured children

Children suffering severe burns develop hypocalcemia, magnesium (Mg) depletion, hypoparathyroidism, and renal resistance to parathyroid hormone (PTH) infusion. We hypothesized that Mg depletion accounted for both the hypoparathyroidism and the renal resistance to PTH, and that Mg repletion would improve both. Due to a lack of PTH for infusion, we studied only the effect of Mg repletion on the relationship between ionized Ca (iCa) and PTH in the serum of 14 sequentially recruited children burned ≥ 40% total body surface area. All received a urinary Mg retention test a median of 20 days post burn (range 8-137 days). Seven (50%) of the children remained Mg depleted, which was not attributable to burn size or to time from burn to study. Combined enteral and parenteral Mg intakes were not different between the depleted and repleted groups, 12.2 ± 4.4 (SD) mg/kg per day and 14.2 ± 6.2 mg/kg per day, respectively. Both groups had low intact PTH levels in relation to serum iCa concentration, indicating persistent hypoparathyroidism. We conclude that Mg depletion is not the chief cause of hypoparathyroidism following thermal injury and we postulate that the persistent hypoparathyroidism is consistent with a reduced set-point for Ca suppression of PTH secretion.