Hypercalcemic crisis in the pediatric emergency department: Answers

Excerpt

A 13-month-old boy presented to the emergency department with failure to thrive, excessive irritability, recent onset polyuria, polydipsia and severe hypercalcemia of uncertain etiology. The child was evaluated for causes of hypercalcemia. Undetectable parathyroid hormone (PTH) and normal serum phosphorus levels ruled out a diagnosis of primary hyperparathyroidism. Despite there being a history of failure to gain weight for last 3 months, counts were normal, and there was no lymphadenopathy or hepatosplenomegaly. Hence, malignancy as a cause of hypercalcemia was less likely. Alkaline phosphatase levels were at the upper limit of normal and a history of failure to gain weight prompted us to consider paraneoplastic syndromes like neuroblastoma, hepatoblastoma, among others. No abdominal mass was detected during the clinical examination, and ultrasonography of the abdomen also did not reveal any such abnormality. Moreover, 1,25(OH)-vitamin D and parathyroid hormone-related protein (PTHrP) levels were subsequently reported to be normal. There was no contact history of tuberculosis, and a chest X-ray did not reveal any evidence of sarcoidosis or tuberculosis. …