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Severe hypercalcemia associated with hypophosphatemia in very premature infants: a case report

Nicola Improda1,2, Francesca Mazzeo3, Alessandro Rossi4

  • 1Department of Translational Medical Sciences, Section of Pediatrics, Federico II University of Naples, Naples, Italy. nicolaimproda@gmail.com.

Italian Journal of Pediatrics
|July 8, 2021
PubMed

Insights

Severe hypercalcemia in newborns, though rare, can occur with hypophosphatemia. Prompt phosphate (PO4) infusion is crucial for managing this condition, alongside careful monitoring of calcium (Ca) levels.

Area of Science:

  • Neonatology
  • Pediatric Endocrinology
  • Biochemistry

Background:

  • Severe hypercalcemia is a rare neonatal condition with potential sequelae.
  • Hypophosphatemia in infants can stem from intrauterine malnutrition, sepsis, or high-energy parenteral nutrition (PN).
  • The mechanism linking hypophosphatemia to severe hypercalcemia in neonates remains unclear, and phosphate (PO4) and calcium (Ca) monitoring in preterm infants is debated.

Observation:

  • A preterm infant (29 weeks gestation) with intrauterine growth retardation (IUGR) presented with sustained severe hypercalcemia (corrected Ca up to 24 mg/dl).
  • The hypercalcemia was attributed to hypophosphatemia during phosphorus-free PN.
  • Initial treatments including hyperhydration and furosemide were ineffective, but hypercalcemia resolved with PO4 infusion.

Findings:

  • Hypophosphatemic hypercalcemia in a neonate responded effectively to phosphate (PO4) infusion.
  • The infant later experienced symptomatic hypocalcemia, potentially worsened by albumin infusion.
  • Normalization of parathyroid hormone (PTH) and alkaline phosphatase (ALP) was observed post-treatment.

Implications:

  • Clinicians must recognize the risk of severe, life-threatening hypercalcemia in neonates with or at risk for hypophosphatemia.
  • Phosphate (PO4) infusion is the primary management strategy for hypophosphatemic hypercalcemia.
  • Close monitoring of both calcium (Ca) and phosphate (PO4) levels is essential during treatment.
Abstract

Keywords:
Case reportExtremely low birth weightHypercalcemiaHypophosphatemiaSmall for gestational age

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