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Hypercalcemia in newborns
Last reviewed: 23.04.2024
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Hypercalcemia is defined as the level of total calcium in the serum above 12 mg / dL (3 mmol / L) or ionized calcium greater than 6 mg / dl (1.5 mmol / L). The most common cause is iatrogenia. There may be signs on the part of the digestive tract (anorexia, vomiting, constipation) and sometimes lethargy or convulsions. Treatment of hypercalcemia is based on intravenous administration of saline with furosemide and sometimes bisphosphonates.
[What causes hypercalcemia?
The most common cause of hypercalcemia is iatrogenia due to excess calcium or vitamin D, or inadequate intake of phosphorus, which may result from prolonged feeding by improperly prepared mixtures or milk with a high content of vitamin D. Other causes include maternal hypoparathyroidism, subcutaneous fatty cell necrosis, hyperplasia parathyroid glands, impaired renal function, Williams syndrome, and there are also cases of idiopathic hypercalcemia. Williams syndrome includes a supernovascular aortic stenosis, an elf face and hypercalcemia of unknown pathogenesis; children may also be small by the time of gestation, and hypercalcemia may be noted in the first months of life, usually passing to the age of 12 months. Idiopathic neonatal hypercalcemia is the diagnosis of an exception, it is difficult to differentiate it from Williams syndrome. Neonatal hyperparathyroidism is very rare. Necrosis of subcutaneous fatty tissue can develop after a significant injury and causes hypercalcemia, which usually occurs spontaneously. Hypoparathyroidism or hypocalcemia in the mother can cause secondary hyperparathyroidism in the fetus, with a change in its mineralization, such as osteopenia.
Symptoms of hypercalcemia
Symptoms of hypercalcemia can be seen at a level of total calcium in the serum of more than 12 mg / dL (> 3 mmol / l). These manifestations may include anorexia, regurgitation, vomiting, inhibition or seizures or general excitability and hypertension. Other symptoms of hypercalcemia include constipation, dehydration, impaired tolerance to food and a delay in weight gain. With subcutaneous necrosis on the trunk, buttocks and legs, you can observe dense purple nodules.
Treatment of hypercalcemia
A marked increase in the level of calcium can be treated by intravenous injection of physiological solution, followed by furosemide, as well as with continued changes by the administration of glucocorticoids and calcitonin. Bisphosphonates are also increasingly used in this situation (for example, etidronate orally or pamidronate intravenously). Treatment of subcutaneous fat necrosis is carried out using mixtures with low calcium content; fluid, furosemide, calcitonin and glucocorticoids are used according to indications depending on the degree of hypercalcemia. Hypercalcaemia in the fetus because of hypoparathyroidism in the mother can be used wait and see tactics, since it usually spontaneously passes for several weeks. Treatment of chronic conditions includes mixtures with a low content of calcium and vitamin D.