From the Research
Management of severe hypercalcemia in pediatric patients requires prompt intervention with aggressive hydration as the first step, followed by the administration of bisphosphonates, such as zoledronic acid, as evidenced by a recent study 1. The initial approach to treating severe hypercalcemia involves increasing the urinary excretion of calcium through hydration and diuretics. Begin with intravenous normal saline at 1.5-2 times maintenance rate to increase renal calcium excretion, while closely monitoring fluid status to avoid overload. Once the patient is adequately hydrated, administer furosemide 1-2 mg/kg/dose every 6-12 hours to enhance calcium excretion. For persistent hypercalcemia, bisphosphonates are effective; zoledronic acid is a suitable option, as shown in a recent case report 1, which may be repeated if necessary. In life-threatening cases, calcitonin can provide rapid but temporary reduction at 4-8 IU/kg subcutaneously or intramuscularly every 6-12 hours. Glucocorticoids (prednisone 1-2 mg/kg/day) are particularly useful when hypercalcemia is due to vitamin D excess or certain malignancies, as discussed in 2 and 3. Throughout treatment, maintain close monitoring of serum calcium, phosphorus, magnesium, and renal function. Addressing the underlying cause is essential for long-term management, as these interventions primarily provide temporary correction. Severe hypercalcemia can cause cardiac arrhythmias, seizures, and altered mental status, so cardiac monitoring and neurological assessments should be performed regularly during treatment, as highlighted in 4. It is crucial to note that the treatment approach may vary depending on the underlying cause of hypercalcemia, and a thorough evaluation is necessary to guide management decisions, as emphasized in 5. Overall, the management of severe hypercalcemia in pediatric patients requires a multifaceted approach, incorporating hydration, bisphosphonates, and other medications, as well as close monitoring and addressing the underlying cause.