Hypercalcemic crisis in children

Hypercalcemic crisis in children is a life-threatening emergency, diagnosed with an increase in the level of calcium in the blood above 3 mmol / l (in term infants - above 2.74 mmol / l, and in premature infants - above 2.5 mmol / l).

[1], [2], [3], [4]

The causes of hypercalcemic crisis in children

The hypercalcemic crisis is observed with exacerbation of untreated primary hyperparathyroidism, with rapid dehydration in patients with primary hyperparathyroidism, in hypervitaminosis B, with rapid development of the acute form of the Burnett syndrome or exacerbation of its chronic form, with severe myeloma, the administration of large amounts of magnesium. In patients with primary hyperparathyroidism, the hypercalcemic crisis can be triggered by pregnancy, fractures, infection, inactivity, intake of absorbed antacids (calcium carbonate).

Among doctors, the mnemonic form (reception for remembering) of the causes of hypercalcemia is popular: "VITAMINS TRAP". This abbreviation does list most of the reasons: V-vitamins, I-immobilization, T-thyrotoxicosis, A-Addison's disease, M-milk-alkaline syndrome, I-inflammatory disorders, N-disease associated with malignancy, S-sarcoidosis, T- thiazide diuretics and other medicines (lithium). R - rhabdomyolysis, A - AIDS, P - Paget's disease, parenteral nutrition, pheochromocytoma and parathyroid gland diseases.

Hypercalcemia is accompanied by diseases that lead to increased leaching of calcium from the bones or a decrease in calcium absorption by bone tissue. Increased absorption of calcium in the intestine and a decrease in its excretion by the kidneys are also capable of provoking hypercalcemia.

Symptoms of hypercalcemic crisis in children

Hypercalcemia is relatively easy to tolerate if it develops gradually, and is very difficult, even mild or moderate, if acute. There is weakness, lack of appetite, nausea, vomiting, consciousness changes from excitement up to sopor and coma. They detect arterial hypertension, arrhythmias, shortening of the QT interval. With a decrease in BCC, hypotension may develop. Characteristic decrease in GFR and concentration ability of the kidneys, polyuria, thirst, nephrocalcinosis and urolithiasis. Calcium excretion can range from low to significantly elevated. Hypercalcemia is often accompanied by peptic ulcer, gastroesophageal reflux, acute pancreatitis, constipation.

Criteria for diagnosis

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

[5], [6], [7], [8], [9], [10], [11]

Emergency medical events

To normalize calcium excretion, infusion of isotonic sodium chloride solution (adolescents up to 4 l / day) is carried out and simultaneously furosemide is administered intravenously at 1 mg / kg 1-4 times a day. With the same purpose, the appointment of glucocorticosteroids (hydrocortisone 5-10 mg / kg, prednisolone 2 mg / kg body weight - intravenously, intramuscularly, orally) has been shown. In severe cases, it is possible to use a prolonged infusion of potassium phosphate 0.25-0.5 mmol / kg. To suppress the resorption of bone tissue, calcitonin preparations are used (the myacalcine is administered on the first day from the calculation of 5-10 IU / kg intravenously dropwise in a 0.9% solution of sodium chloride every 6-12 hours, then in the same daily dose intramuscularly 1-2 times in day). It is necessary to limit the intake of foods containing high amounts of calcium, stop taking medications of vitamin D.

After the elimination of life-threatening hypercalcemia in primary hyperparathyroidism, surgical treatment is performed.

[12], [13], [14]