A 2.3-kg female infant was born by spontaneous vaginal delivery with Apgar scores of 1 and 7 at one and five minutes, respectively. Cyanosis was present, as was a grade 2/6 systolic murmur. Cardiac catheterization on day 4 of life was diagnostic of truncus arteriosus. Abnormal laboratory findings included hypocarboxemia (carbon dioxide content, 18 mEq/L), and hypocalcemia (calcium level, 5.8 mEq/L); these improved slightly with intravenous (IV) calcium gluconate. Congestive heart failure was treated with digoxin, furosemide, and spironolactone. A chest roentgenogram was performed at 4 weeks of age (Fig 1), and a collimated view of the right arm (Fig 2) was obtained at 6 weeks of age.
Denouement and Discussion
Soft-Tissue Calcification Caused by Calcium Gluconate Extravasation
Soft-tissue calcification caused by extravasation of calcium gluconate solutions has been recognized since 1936.1 Evidence of soft-tissue injury may not be apparent for several weeks, and skin sloughing may occur.2