Hypercalcemia

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Hypercalcemia

Author: Pediatric Oncall

Question
A 1½-month-old girl born of non-consanguineous marriage presented with fever for 5 days, thickening of the skin over back, arms since 15 days of life. She was born of a post term caesarean section, had meconium aspiration and required ventilatory support postnatally and required NICU stay for 15 days. She was immunized till OPV & BCG and was on exclusive breastfeeds. On examination, the child was irritable, weight was 4.25 kg with subcutaneous fat necrosis over back, arms, and thighs and crepitations in right lower zone. Other systems were normal. She was found to have hypercalcemia (serum calcium = 12.4 mg% and ionic calcium = 2.28 mmol/L).

What is the treatment of hypercalcemia?

Answer Discussion :

M

Manish Rawat

0

fiver

4 Days ago

M

Manish Rawat

0

pilis

4 Days ago

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Answer 1

Treatment of hypercalcemia consists of
• Hydration with diuresis
• IV Pamidronate
• Steroids if hypercalcemia is due to 1, 25 dihydroxy Vitamin D overproduction.

The initial step would be to give 1½ times to twice the maintenance fluids followed by Furosemide to cause loss of calcium in the urine. If that does not resolve the hypercalcemia, then IV Pamidronate (bisphosphonates) are useful to suppress osteoclastic activity and thus prevent resorption of calcium from the bones.

An oral short course of steroids may be useful to decrease intestinal absorption of calcium in cases of hypervitaminosis D. The goal of therapy is to normalize ionic calcium levels to prevent sudden cardiac arrhythmias.

Hypercalcemia

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