Dear all,

 

can anyone post any guideline to guide us to manage a 7 day old neonate with hypercalcaemia.

Trying to get hold off very specific information about when to start Fursemide (the cut off level for cCa), the dose and when to start bisphosphonates?

Thank you.

 

BW,

Lenka

Sure you will be provided with guidelines here ..but allow me to mention some points according to my view ...we should treat the cause first and I think we should revise the nutrients  intake of this baby either intravenous fluids ; total parentral nutrition or even milk formula if bottle fed .

Rule out Parathyroidism too

@Lenks Concerning hypercalcemia (total Calcium of 12 mg/dL is our cutoff for IV saline 10-20 ml/kg with 1 mg/kg lasix. A  persistent hypercalcemia in-spite the lasix and total Calcium above 14 mg/dL we would consider glucocorticoids.   No experience with bisphosphonates.

Calcium intake should be thoroughly reviewed. Although day 7 is early for subcutaneous fat necrosis to cause hypercalcemia, but checking for sites of it could be advised, Further lab. data to know the etiology: ionized calcium, pH, albumin, phosphorus, alkaline phosphatase, PTH, urine sample for spot calcium/creatinine ratio, 25 OH Vit D and 1, 25 OH Vit D. Ask mother and father for Familial hypocalciuric hypercalcemia (autosomal dominant) or check their urine spot calcium/creatinine ratio.

 

I've used roughly the same thresholds as Hamed, fudging a little higher or lower based on symptoms.  In addition to the collateral information Hamed recommended, the single biggest thing to figure out (in my experience) is whether this is iatrogenic or not.  Often times, iatrogenic hypercalcemia even at high levels, can self-correct whereas if there is a real underlying cause, that too can suggest definitive therapy.  Assuming it is not iatrogenic and the Family history is non-contributory, I would at least consider a diagnosis of William's Syndrome.

@Lenks I do agree with @bimalc,  as many of these cases are transient and seem to resolve spontaneously without any specific treatment. In case high Ca intake is suspected to be the cause of hypercalcemia, discontinuing  powdered human milk fortifier or preterm formula to first stop this extra intake and closely monitor serum calcium levels without immediate further evaluation. Additionally consider temporarily discontinuing vitamin D supplementation if providing. In case spontaneous correction of serum Ca doesn't take place further invitations as mentioned above with adding renal ultrasound when hypercalciuria is present.