Hypercalcaemia in children

 

Causes

Neonates

 – Excessive supplementation of calcium

 – Hypophosphatasia

 – Subcutaneous fat necrosis

 – William syndrome

 – Hyperparathyroidism 1⁰ or 2⁰

 – Idiopathicinfantile hypercalcaemia.

 

Older children

 – Hyperparathyroidism (parathyroid adenoma, 1⁰ or 2⁰ cause)

 – Malignancies- Non-Hodgkin or Hodgkins lymphoma, Ewing sarcoma, rhabdomyosarcoma etc

 – Granulomatous diseases (Sarcoidosis, tuberculosis, etc)

 – Others- Thiazide diuretics; milk alkali syndrome; thyrotoxicosis; prolonged immobilization, renal failure

 

Clinical presentation

Most children are asymptomatic or may cause lethargy, weakness or reduced consciousness

Hypercalcaemia may cause nausea, vomiting, loss of appetite; failure to thrive or constipation.

Renal disorders may be associated with polyuria, polydipsia or kidney stones

There may be ectopic calcifications in various organs

Examination may show low HR, high BP, reduced tendon reflexes

 

Investigations

 – Check Calcium, Phosphate, Alk Phos, Vit D, PTH and TSH

 – Assess Urinary calcium excretion (spot UCa:UCr ratio; or 24hr UCa excretion)

 – US Kidneys to look for nephrocalcinosis

 

Management

 – Mild asymptomatic hypercalcaemia may only require monitoring and management of underlying cause

 – Hypercalcaemia responds to hydration with 0.9% Saline, as sodium excretion also increases renal calcium excretion

 – Frusemide also increases calcium excretion in urine

 – Bisphosphonates are sometimes used to treat hypercalcemia due to malignancy or hyperparathyroidism by increasing reabsorption of calcium in bones

 – Surgical subtotal parathyroidectomy may help in hyperparathyroidism especially if causing recurrent renal stones.

 – Peritoneal dialysis or hemodialysis is helpful in hypercalcaemia due to renal failure