Pediatric Hypercalcemia Clinical Presentation

Updated: Jun 09, 2022
  • Author: Pisit (Duke) Pitukcheewanont, MD; Chief Editor: Sasigarn A Bowden, MD  more...
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Presentation

History

Hypercalcemia can cause symptoms at levels as low as 12 mg/dL and consistently causes symptoms at 15 mg/dL. Hypercalcemia initially and predominantly affects the GI and nervous systems. Symptoms include the following:

  • Nervous system

    • Personality changes

    • Malaise

    • Headache

    • Hallucinations

    • Unsteady gait

    • Proximal muscle weakness

    • CNS depression

    • Irritability

    • Confusion

  • GI system

    • Hypercalcemia can cause a paralytic ileus, with resultant abdominal cramping, constipation, anorexia, nausea, and vomiting.

    • Ectopic calcification can lead to symptoms of pancreatitis, with epigastric pain and vomiting.

    • Increased gastric acid secretion may produce symptoms consistent with gastritis.

  • Renal symptoms

  • Musculoskeletal system - Bone pain

  • Ectopic calcification

    • Pruritus

    • Conjunctivitis

  • Miscellaneous symptoms

    • Congenital deformity

    • Other symptoms of malignancy

    • Symptoms of other underlying causes of hypercalcemia

    • Hypercalcemia-associated acute respiratory distress syndrome (rare) [11]

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Physical Examination

Vital signs include the following:

Neurologic examination findings include the following:

  • Depressed sensorium

  • Confusion

  • Gait disturbances

  • Hyporeflexia

  • Proximal muscle weakness

Even at lower levels, patients can have renal failure and ectopic calcification, including renal stones and pancreatitis.

Ectopic calcification can also manifest as conjunctivitis or band keratopathy on eye examinations.

Neonates may be asymptomatic or may have vomiting, hypotonia, hypertension, or seizures.

At levels of 17 mg/dL, calcium phosphate precipitation through the blood and soft tissues can lead to coma or lethal cardiac arrest.

Hypercalcemia is often asymptomatic. If hypercalcemia is symptomatic, the differential diagnosis rests heavily on the predominating symptom.

Weakness and altered sensorium may be symptomatic of a myriad of neurologic disorders, as well as toxins (eg, organophosphate poisoning), lupus, or thyroid dysregulation.

Weakness alone may be confused with hypokalemia, whereas ataxia is found in phenytoin overdoses, mass lesions, stroke syndromes, and encephalitides.

Hypertension may indicate a cardiac or renal problem.

Many manifestations of hypercalcemia (eg, pancreatitis, renal stones, gastritis, conjunctivitis) may be caused by etiologies different from hypercalcemia.

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