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Preeti
I am a final yr medical student and i just love ur website!!! I regularly use it to help me with my preparations. The topics are so lucidly written and easily understood with up to date information.. Even the HIV related web site ( www.hivinchildren.org) by Dr.Ira Shah is just fabulous!!! |
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Dr Parang N Mehta
Dear Dr Ira Shah, Congratulations on putting up an excellent website, which will be of great use to practicing pediatricians everywhere. You have achieved the near impossible in getting some of the biggest names in pediatrics in India to contribute content to your site. |
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| Sailala
An excellent website!! good and useful information! Many Thanks for to u all! |
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Sujatha
Very informative site, and queries are getting resolved immediately. Thanks |
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Uttam Laisram
I found the Vaccine Reminder feature on your Website very interesting. My request is that this useful facility may not be restricted to Registered Users, but may be made available to all Visitors, who may like to enter their child's details and take a print-out of the Vaccine schedule. Please consider. Keep up the excellent work in providing India-relevant information for child care. |
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Dr Ira Shah
M.D, DNB, DCH(Gold Medalist), FCPS
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Causes of Hypercalcemia in children :
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Hypervitaminosis D
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Nutritional |
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Inflammatory / Granulomatous / Neoplastic diseases
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Hyperparathyroidism
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Sporadic (Adenoma, Hyperplasia) |
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Familial (Isolated, MEN I & IIa)
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Familial Hypocalciuric hypercalcemia
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Immobilization
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Others
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Hypophosphatemia |
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Drugs (Thiazides, Vitamin A, Calcium, alkali, aluminium excess)
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Hyperthyroidism
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Adrenal insufficiency
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Pheochromocytoma
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William’s syndrome |
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Evaluation of a child with hypercalcemia –
A history for excessive exposure to Vitamin D, Vitamin A or calcium or thiazide diuretics should be taken. Examination for neoplasms should be undertaken.
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Many patients with slight hypercalcemia (<12 mg/dl) are asymptomatic. In moderately hypercalcemic subjects (12-13.5mg/dl), patients have weakness, anorexia, impaired concentration, constipation, polyuria and polydipsia as calcium acts as an osmotic diuretic. Severely hypercalcemic child (calcium >13.5 mg/dl) presents with nausea, vomiting, dehydration and altered conciousness. Infants also have failure to thrive. Some patients may have pancreatitis, peptic ulcer and nephrolithiasis.
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A child with hypercalcemia should have a baseline total and ionic calcium, phosphorus and urine calcium excretion tests. If urine calcium is less, it suggests Familial Hypocalciuric hypercalcemia. If urine calcium is elevated, one should do serum PTH levels. If PTH levels are high, it suggest Primary hyperparathyroidism. If it is low, it suggests hypophosphatemia or Vitamin D excess.
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Management of hypercalcemia :
When total calcium concentration is more than 13.5 to 14 mg/dl, emergency intervention is often necessary due to the adverse effects of hypercalcemia on cardiac, CNS, renal and GI functions. Hydration with isotonic saline (twice maintenance volume) restores intravascular volume, dilutes and decreases serum Ca2+ levels and increases glomerular filtration of ionic calcium. After hydration, IV furosemide (1 mg/kg) inhibits renal tubular reabsortion of Ca++, further increasing calciuresis.
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If hypercalcemia does not respond to the above measures, calcitonin (4U/kg SC every 12 hourly), osteoclast inhibitors – bisphosphonates may be used. In patients with hematological malignancies or excessive Vitamin D, glucocorticoids may also be useful. When hypercalcemia is moderate, aggressive medical therapy is usually not indicated unless the patient is symptomatic.
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Treatment of specific cause:
Hypercalcemia due to Vitamin D intoxication responds to the withdrawl of Vitamin D or administration of corticosteroids by impairing intestinal absorption of calcium and depressing expression of 25 hydroxy Vitamin D3 hydroxylase.
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Hypercalcemia due to granulomatous disorder may respond to ketoconazole.
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In children or adolescents with parathyroid adenoma, surgical removal of the adenoma is recommended. In patients with nonfamilial hyperplasia of parathyroid gland, subtotal parathyroidectomy is recommended.
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For children and adolescents with familial hypocalciuric hypercalcemia, no aggressive therapy to required. However, neonates with severe life-threatening hypercalcemia may require emergency parathyroidectomy for survival.
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References
- Pediatric Endocrinology – Sperling M.A. – 1st ed, USA, W.B. Saunders 1996 – pg 487 to 493.
Last Updated on 11-08-2007
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