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 Hypercalcemia in infants: about 3 observations
Barka M, Kebaili R, Tilouche S, Tej A, Soyah N, Bouguila J, Boughammoura L. Department of Pediatrics, CHU

Farhat Hached Sousse, Tunisia.

Introduction: Hypercalcemia in newborns and infants is often iatrogenic. Clinical signs are correlated with the severity of hypercalcemia and can be life threatening by several
mechanisms: dehydration, neurological disorders with convulsions, heart rhythm disorders....

Objective: To study the clinical, biological, etiological and therapeutic aspects of hypercalcemia in infants.

Materials and methods: This is a retrospective study conducted on three patients hospitalized in the Pediatrics Department of the Farhat Hached University Hospital in Sousse for the
management of hypercalcemia, defined as a total serum calcium level >2.7 mmol/l, between 2014 and 2019.

Results :

Patient Clinical signs Initial Other balance sheets Dosage of 25 OH Treatment Evolution Etiology used
(Gender Calcemia vitamin D
Age )

Patient 1 - 5 mmol/l Hypokalemia > 1OO ng/ml -Hyperhydration IV -Very progressive Hypersensitivity to
Uncontrollable Functional Renal Control : - Furosemide decrease in blood vitamin D: this was the
Boy vomiting Failure Hyper 55 ng/ml after 1 -Bipohsphonates calcium levels: first and only intake of
6 -Dehydration Calciuria Renal month (Pamidronate) 1mg/kg/d x normalization at D45 200,000 IU (Vitamin D3
months - Hypotonia, Echo : 3d -Nosocomial infection, BON®) at 6 months.
and a drowsiness Nephrocalcinosis stage septic EDC, assisted
half - ECG: normal 2 ventilation...
- Favourable Suites

Patient 2 - Weight Stagnation 3.7 mmol/l Hypokalemia > 100 ng/ml -Hyperhydration IV -Decrease in blood Intoxication with the
- dehydration Functional Renal - Furosemide calcium levels in 5 days vitamin D following an
Girl - Vomiting Failure Hyper -Zoledronic acid (Zometa) -Rapid weight error of administration: 1
40 days - Lethargy Calciuria Renal 0.05mg/kg in a single dose. improvement, dose of Vitamin D3 GOOD
Echo : neurological status to D15 + 1200 UI of
Nephrocalcinosis stage Sterogyl® /d
2 (Ergocalciferol) for 1
month

Patient 3 -weight stagnation 3.2 mmol/l Hypokalemia 90 ng/ml -Hyperhydration IV -Normalization of Hypersensitivity to
- Dehydration Functional Renal - Furosemide blood calcium at vitamin D
Boy 45 - irritability Failure Hyper - Prednisone 1 mg/kg/d x 7d D10 Following a single dose
days Calciuria Renal -Favourable clinical of Vitamin D3 BON® at
Echo : evolution D15
Nephrocalcinosis stage
2

Discussion :
The clinical signs of hypercalcemia are not very specific, correlating with the etiology and degree of hypercalcemia.hypercalcemia, associating anorexia, nausea, vomiting, food intolerance,
weight stagnation, constipation, abdominal pain, polyuria, dehydration, lethargy, high blood pressure, cardiac conduction disorders and neurological manifestations such as irritability,
convulsions, consciousness disorders, drowsiness, hyperreactivity and even coma.
The etiologies are dominated by iatrogenic causes, linked to an excess of calcium or vitamin D, which may result from prolonged feeding with poorly prepared artificial milk, an administration
error (such as our 2nd case) or hypersensitivity to vitD (CYP24A1), but also hyper-parathyroidism by inhibitory mutation of the calcium sensor receptor (CaSR) or Willams and Beuren syndrome.
Management depends on the rate of serum calcium levels and clinical tolerance: hyperhydration by physiological saline 9‰ , furosemide, Prednisone: 0.5-2mg/kg/day, pamidronate: 1mg/kg,
ketoconazole: 3mg/kg/8h. We used zoledronic acid in 1 case after parental consent.

Conclusion: Vitamin D should be administered cautiously to infants because of the risk of inadvertent intoxication or hypersensitivity.