Pediatric Hypercalcemia Follow-up

Updated: Aug 11, 2017
  • Author: Pisit (Duke) Pitukcheewanont, MD; Chief Editor: Sasigarn A Bowden, MD  more...
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Follow-up

Further Outpatient Care

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  • Daily calcium intake should be limited, and restriction of vitamin D (sunlight, dairy) may be warranted in certain disorders.
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Further Inpatient Care

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  • Admit any patient requiring treatment for hypercalcemia.
    • Continue the previously mentioned medications as needed.
    • Continue an appropriate workup for the etiology of hypercalcemia.
  • For neonates, specifically, Oski recommends 5% dextrose (D5) in one-half isotonic sodium chloride solution with 30 mEq/L potassium chloride at 2 times the maintenance dose along with 2-3 mg/kg/d furosemide and adequate phosphate supplementation to maintain normal levels. [15] Strongly consider surgical correction of primary hyperparathyroidism.
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Inpatient & Outpatient Medications

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  • Long-term therapy can begin while the patient is in the hospital and continue following discharge.
  • Corticosteroids are helpful in certain disorders, particularly malignancy-associated hypercalcemia, granulomatous disease, or vitamin D ingestion; and they can be given either IV or orally as prednisone in doses of 40-60 mg/m 2/d or 1.5-2 mg/kg/d to inhibit osteoclast action and decrease intestinal calcium absorption.
  • Aminohydroxypropylidene (APD) can induce remissions of malignancy-associated hypercalcemia.
  • If serum phosphate is low, intravenous (IV) phosphorus is no longer recommended because of the risk of intravascular precipitation with calcium; however, oral phosphate supplementation is recommended because this binds calcium in the intestine and diminishes calcium absorption. The dose is 1-3 g/d for an adult-sized person. Phosphate is contraindicated in renal failure and requires 2-3 days before it becomes effective.
  • Bisphosphonates may also be continued as outpatient medications. One should consider alendronate as an oral preparation. However, note that no pediatric experience is noted.
  • Indocin may be of some use in certain disorders that lead to hypercalcemia.
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Transfer

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  • As in any patient, transfer is acceptable when patient is stable or when a higher level of care is required. However, consider the possibility of coma or cardiovascular collapse in a patient with an excessively high calcium level. Begin close observation/therapy before transfer.
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Deterrence/Prevention

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  • Carefully monitor patients with risk factors for hypercalcemia, such as known malignancy, thiazide diuretic use, total parenteral nutrition, retinoid use for acne, or lithium use.
  • Counsel patients to consume adequate phosphate and to avoid excessive calcium-containing antacids, vitamin D, and herbal preparations with vitamin A.
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Complications

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  • Primarily ectopic calcifications may occur (see Physical).
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Prognosis

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  • Hypercalcemia is frequently noted during laboratory testing while the patient is asymptomatic or mildly symptomatic. Prognosis depends on the underlying disorder.
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