Table III.
Chart review for patients with significant hypercalcemia (sorted by age)
| Patient ID | Elevated blood Ca level | Relevant laboratory results | Treatment plan | Medications | Relevant history |
|---|---|---|---|---|---|
| WBS_123 | 12.8 mg/dL at age 0.83 y on admission, rose to 13.8 mg/dL in hospital; 11.3 mg/dL at age 1.28 y | Cr 2.3 mg/dL, later stabilized to 0.6 mg/dL at age 0.83 y | Calcilo for 18 mo | None listed | FTT (0.83 y) plus gastrostomy tube; small echogenic kidneys and loss of corticomedullary differentiation; stage II chronic kidney disease; long QT syndrome due to familial KCN mutation (maternally inherited) |
| WBS_191 | 12.1 mg/dL at age 0.86 y | Not available | Calcilo for approximately 24 mo | Atenolol, Synthyroid, Xopenex, Pulmicort | Atypical WBS deletion (8 Mb) and fibrillin 1 mutation; history of hypothyroidism, seizures, microcephaly, spasticity, and constipation |
| WBS_181 | 11.4 mg/dL at age 0.91 y; 12.9 mg/dL at age 1.08 y; 11.7 mg/dL at age 1.08 y (repeated measurement) | Increased oxalate in urine | Primary hyperoxaliuria type II was the presumptive diagnosis. Treated with K citrate at age 0.91 y. No change in diet until WS diagnosis, then dietary Ca restriction. | None listed | Diagnosed with WBS at 1.17 y; history of FTT, undescended testes, and anterior anus; bilateral nephrocalcinosis (0.83 y); remains on K citrate, Ca intake is normalized, and Ca level is currently normal |
| WBS_120 | 12.1 mg/dL at age 1.04 y, stabilized to 9.8 mg/dL by the end of hospitalization; 10.8 mg/dL at age 1.04 y initially after surgery | Not available | Iatrogenic. Reduced Ca gluconate infusion rate | Zyrtec | Branch pulmonary arterioplasty and repair of SVAS; following surgery, epinephrine infusion of 0.03 mg/kg/min and Ca gluconate infusion of 40 mg/kg/min; history of hypercalciuria |
| WBS_164 | 17.7 mg/dL at age 1.05 y | Not available | Acute treatment: IV hydration, Lasix, and calcitonin. Placed on Calcilo, 30 oz/d. | Prevacid | Presented to emergency department with complaints of fussiness and irritability; constipation and hypercalciuria were concurrent complaints; history of hypothyroidism, GERD, FTT; nephrocalcinosis at age 1.33 y |
| WBS_163 | 11.2 mg/dL at age 1.05 y; 11.2 mg/dL at age 2.05 y | Not available | No treatment | None listed | High Ca on routine test; irritability and constipation; history of pulmonary valvular stenosis and SVAS |
| WBS_109 | 11.3 mg/dL at age 1.25 y | Not available | Discontinue multivitamin preparation; limit dairy intake to <24 oz/d | Multivitamin use before hypercalcemia | Birth at 32 weeks gestation; history of FTT; asymptomatic, but history of gagging with occasional vomiting; bilateral mild/moderate nephrocalcinosis at age 2.84 y |
| WBS_146 | 12.2 mg/dL initially, then 14.9 mg/dL at age 1.47 y | 25-OH vitamin D level: 17 mg/dL at age 3.01 y | Acute treatment: IV hydration, Lasix, and pamidronate. Low-Ca diet and Calico for 20 mo (until age 3.01 y) | 400 IU citamin D for 10 mo due to low 25-hydroxy vitamin D levels at age 3.01 y; switched to multivitamin after. | History of FTT, colic, and constipation; atypical deletion (>2 Mb) and autism spectrum disorder; SVAS; nephrocalcinosis at age 2.97 y |
| WBS_115 | 10.8 mg/dL at age 15.66 y | 25-OH vitamin D levels: 15 mg/dL and 25 mg/dL at age 15.66 y Urine Ca: low | Observation | Amlodipine Labetalol | No hypercalcemia as an infant; long-standing hypertension; very limited dairy intake |
| WBS_167 | 11.1 mg/dL at age 19.33 y | BUN: 22 mg/dL Cr: 0.74 mg/dL (high for the patient’s size) GFR: 77 mL/min/1.73 m2 | Discontinue multivitamins; calcium stabilized on improved pureed food diet | Multivitamins and special milkshakes (to meet caloric needs) | Gastrointestinal dysmotility and esophageal bezoar; malnutrition, dehydration, and right pelvic kidney |
| WBS_158 | 11.5 mg/dL at age 20.51 y | Not available. | Recommendation to decrease milk intake and multivitamin use | Multivitamins and DDAVP use at time of hypercalcemia | Subject was consuming cheese, but not milk at time of hypercalcemia. |
| WBS_186 | 11.4 mg/dL at age 26.47 y | Urine Ca (24 h): 390 mg at age 26.21 y PTH: 79 pg/mL at age 26.21 y; 108 pg/mL at age 26.77 y 25-OH vitamin D: 22 mg/dL at age 26.46 y | Parathyroidectomy | None listed | Parathyroid adenoma contributing to hypercalcemia; history of Burkitt lymphoma, protein calorie malnutrition, and renal calculi |
| WBS_153 | 11.4 mg/dL at age 30.66 y; 12.1 mg/dL at age 30.82 y | PTH level: 78 pg/mL at age 30.66 y; 90 pg/mL at age; 30.82 mg/dL at age 25-hydroxy vitamin D level: 43.4 mg/dL at age 31.21 y; 38.6 mg/dL at age 30.61 y | Parathyroidectomy at age 31.08 y | Multivitamin; 600 mg Ca and 400 IU vitamin D after parathyroidectomy | Hyperparathyroidism contributing to hypercalcemia at age 30.82 y; hypercalcemia noted on routine testing; history of GERD and hypertension |
| WBS_199 | 10.9 mg/dL at age 39 y | 25-OH vitamin D level: 15.1 mg/dL at age 36 y; 32.3 mg/dL at 1 mo after hypercalcemia | No treatment; no change in multivitamin use | 500 IU vitamin D at age 36 yo; 400 IU + Therobec, a reduced vitamin D multivitamin at age 38 y; Centrum multivitamin at age 39 y to present; oral contraceptive for menstrual control | Mild osteopenia |
DDAVP, desmopressin; FTT, failure to thrive; GERD, gastroesophageal reflux disease; IV, intravenous.