Hypercalcemic crisis in children

Hypercalcemic crisis in children is a life-threatening emergency condition diagnosed when the calcium level in the blood increases above 3 mmol/l (in full-term newborns - above 2.74 mmol/l, and in premature babies - above 2.5 mmol/l).

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Causes of hypercalcemic crisis in children

Hypercalcemic crisis is observed in the case of exacerbation of untreated primary hyperparathyroidism, rapid dehydration in patients with primary hyperparathyroidism, hypervitaminosis B, rapid development of the acute form of Burnett syndrome or exacerbation of its chronic form, severe myeloma, administration of large amounts of magnesium. In patients with primary hyperparathyroidism, hypercalcemic crisis can be provoked by pregnancy, fractures, infection, low mobility, and the use of absorbable antacids (calcium carbonate).

A popular mnemonic device among physicians for the causes of hypercalcemia is "VITAMINS TRAP." This acronym actually lists most of the causes: V - vitamins, I - immobilization, T - thyrotoxicosis, A - Addison's disease, M - milk-alkali syndrome, I - inflammatory disorders, N - disease associated with neoplasms, S - sarcoidosis, T - thiazide diuretics and other drugs (lithium). R - rhabdomyolysis, A - AIDS, P - Paget's disease, parenteral nutrition, pheochromocytoma, and parathyroid disease.

Hypercalcemia is accompanied by diseases that lead to increased leaching of calcium from bones or decreased absorption of calcium by bone tissue. Increased absorption of calcium in the intestine and decreased excretion by the kidneys can also provoke hypercalcemia.

Symptoms of hypercalcemic crisis in children

Hypercalcemia is relatively easy to tolerate if it develops gradually, and very hard, even mild or moderate, if it develops acutely. Weakness, loss of appetite, nausea, vomiting appear, consciousness changes from excitement to stupor and coma. Arterial hypertension, arrhythmia, shortening of the QT interval are detected. With a decrease in the BCC, arterial hypotension may develop. Characteristics include a decrease in SCF and the concentration capacity of the kidneys, polyuria, thirst, nephrocalcinosis and urolithiasis. Calcium excretion can fluctuate from low to significantly increased. Hypercalcemia is often accompanied by peptic ulcer disease, gastroesophageal reflux, acute pancreatitis, constipation.

Diagnosis criteria

The presence and clinical manifestations of diseases accompanied by hypercalcemia. Detection of concomitant alkalosis, hypochloremia, hypokalemia and hypophosphatemia. Enlargement of the parathyroid glands, recorded by ultrasound, CT with contrast and MRI, using subtraction scintigraphy with ²⁰¹ T1 and ^99m Tc, phlebography.

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Emergency medical measures

To normalize calcium excretion, an infusion of isotonic sodium chloride solution is performed (for adolescents up to 4 l/day) and simultaneously furosemide is prescribed intravenously at 1 mg/kg 1-4 times a day. For the same purpose, glucocorticosteroids are indicated (hydrocortisone 5-10 mg/kg, prednisolone 2 mg/kg of body weight - intravenously, intramuscularly or orally). In severe cases, a long-term infusion of potassium phosphate 0.25-0.5 mmol/kg can be used. To suppress bone resorption, calcitonin preparations are used (miacalcic is administered on the first day at a rate of 5-10 IU/kg intravenously by drip in 0.9% sodium chloride solution every 6-12 hours; then at the same daily dose intramuscularly 1-2 times a day). It is necessary to limit the consumption of foods containing an increased amount of calcium, stop taking vitamin D preparations.

After life-threatening hypercalcemia in primary hyperparathyroidism has been corrected, surgical treatment is performed.

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