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Severe hypercalcemia of an infant due to vitamin D toxicity associated with hypercholesterolemia
O Evliyaoğlu1, M Berberoğlu, G Ocal
1Pediatric Endocrinology Department, University of Ankara, School of Medicine, Turkey. cevliyaoglu@hotmail.com
Insights
Severe hypercalcemia in an infant, linked to high vitamin D, also caused temporary hyperlipidemia. Treatment normalized calcium levels, resolving the hyperlipidemia and potentially mitigating hypercalcemic symptoms.
Area of Science:
- Pediatric Endocrinology
- Clinical Biochemistry
Background:
- Vitamin D administration is crucial for bone health but requires careful monitoring.
- Severe hypercalcemia can manifest with diverse clinical presentations.
Observation:
- An 11-month-old infant presented with severe hypercalcemia (serum calcium 5.5 mmol/l) and significant hyperlipidemia after vitamin D bolus therapy.
- Clinical signs of dehydration and irritability were disproportionately mild given the high calcium levels.
- Lipid profile showed elevated total cholesterol, LDL-C, VLDL, and triglycerides.
Findings:
- Treatment with intravenous fluids, furosemide, steroids, calcitonin, magnesium sulfate, and phosphorus led to a decline in serum calcium below 3 mmol/l within 16 days.
- Hyperlipidemia gradually resolved in parallel with the normalization of serum calcium levels.
- The transient nature of hyperlipidemia suggests a direct link to hypercalcemia.
Implications:
- This case highlights a potential association between vitamin D-induced hypercalcemia and transient hyperlipidemia in infants.
- The resolution of hyperlipidemia with normocalcemia may offer a protective effect against severe hypercalcemic symptoms.
- Careful monitoring of both calcium and lipid levels is essential during high-dose vitamin D therapy.
Abstract:
We report an 11 month-old infant with severe hypercalcemia associated with hyperlipidemia following bolus vitamin D administration. At the time of admission, serum concentration of calcium was 5.5 mmol/l (22 mg/dl); total cholesterol, high density lipoprotein cholesterol (HDL-C), very low density lipoprotein (VLDL), low density lipoprotein cholesterol (LDL-C), and triglyceride levels were respectively: 6.37 mmol/l (246 mg/dl), 0.77 mmol/l (30 mg/dl), 1.37 mmol/l (54 mg/dl), 4.1 mmol/l (162 mg/dl), 3 mmol/l (271 mg/dl). Physical examination revealed dehydration and irritability that was inappropriately mild according to the serum calcium level. On the 16th day of therapy that consisted of intravenous fluids with furosemide (sodium diuresis), steroid, calcitonin, magnesium sulfate, and phosphorus, serum calcium level declined below 3 mmol/l (12 mg/dl). The hyperlipidemia resolved gradually with a concomitant decline in serum calcium. This report is interesting in that hypercalcemia was associated with transient hyperlipidemia that disappeared with normocalcemia, which might suggest protection against hypercalcemic symptoms.