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2009 Southern Regional Meeting Abstracts

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Session: Pediatric Clinical Symposium

Cuevas M. USA Children's and Women's Hospital, Mobile, AL.

Case Report: Hypercalcemia is not a common pediatric problem. Although believed to be less common in children versus adults, the actual incidence is unknown. 50 odd cases reported in USA during the past 14 years.
8 m/o WM who was admitted for FFT and noted to have hypercalcelmia. (Ca 15.6)
PMHx significant for: At 5 m/o; 5-10 episodes of diarrhea/day. GI, Dx w/ milk protein allergy and reflux. Pt started on Prevacid, Zantac, and Neocate. Since 5 m/o, the weight had been below 5th percentile for age. At 7 m/o presented with anorexia, drank 10-12 oz/day of formula.
Immediate fluid therapy was initiated. Endocrinology involved, steroids used. Rest of evaluation showed normal thyroid function, parathyroid, Vit D 25-OH and 1-25, PTHrP; iCa, renal US and skeletal survey.
Idiopathic infantile hypercalcemia is a poorly understood disorder manifested by failure to thrive and hypercalcemia during the 1st year of life, followed by spontaneous remission. It can be classified roughly into two forms.
Mild form: Hypercalcemia is the principal disturbance. Characteristically, there is FTT, usually of sudden onset between 3 and 7 m/o. While the sequeale of hypercalcemia is normally completely reversible with therapy, and probably even without therapy, a few patients have died during the acute hypercalcemic phase.
Severe form: Infants with severe form have hypercalcemia and FFT of a degree similar to or greater than in the mild cases. In addition, several other more serious features occur. Recent publications have pointed out that, the severe form of infantile hypercalcemia frequently has its inception in utero.
On our case, we can conclude that this patient had the mild form of idiophatic hypercalcemia of infancy. At hospital discharge, the patient had mild hypercalcemia Six months later, normocalcemia was obtained. Treatment consists of marked restriction of calcium intake, temporary elimination of both vitamin D and sunlight, and occasionally, administration of cortisone. Long-term prognosis is excellent.

15 days prior:

137 100 12 99
4.5 26 0.2 Ca 13.5

At admission:
135 99 14 75
7.3 23 0.2 Ca 15.6

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