Persistent hypercalcemia mimicking hypophosphatasia after discontinuation of a ketogenic diet: a case report.
J Pediatr Endocrinol Metab
; 36(11): 1109-1113, 2023 Nov 27.
Article
in En
| MEDLINE
| ID: mdl-37791799
ABSTRACT
OBJECTIVES:
Hypercalcemia has been reported as an uncommon complication of the ketogenic diet (KD). Here we present a toddler whose hypercalcemia persisted for 2 months after stopping the KD. CASE PRESENTATION A 2 year 11-month-old child with global developmental delay, infantile spasms, neuromuscular weakness with limited mobility, tracheostomy and ventilator dependence, and oropharyngeal dysphagia with G-tube dependence presented with hypercalcemia in the setting of recurrent vomiting. At presentation, the patient was adherent to a KD and taking topiramate since infancy for intractable seizures. His laboratory parameters at presentation showed hypercalcemia (11.9â¯mg/dL), hypercalciuria, acute renal failure, low alkaline phosphatase (76â¯IU/L [110-302â¯IU/L]), parathyroid hormone (PTH) <6â¯pg/mL (18-80â¯pg/mL), normal thyroid function, cortisol and vitamin D level. The patient's hypercalcemia persisted post-discontinuation of the KD and topiramate. PTH-related protein was mildly elevated at 15.3â¯pmol/L. Follow-up laboratory and imaging studies ruled out malignancy. He was managed with calcitonin 4â¯u/kg/dose Q12H × 1 day and 8â¯u/kg/dose Q8H × 1 day, hydration and low-calcium formula. Post-discontinuation of the KD, normalization of alkaline phosphatase levels preceded the normalization of calcium on day 55 and PTH on day 85.CONCLUSIONS:
Hypercalcemia may persist for an extended period after weaning from a KD; lab parameters may mimic that of hypophosphatasia as previously described in the literature. Normalization of alkaline phosphatase, a marker of bone turnover, indicates recovery from the adynamic state induced by the KD and typically precedes the normalization of calcium and PTH.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Diet, Ketogenic
/
Hypercalcemia
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Hypophosphatasia
Limits:
Humans
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Infant
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Male
Language:
En
Journal:
J Pediatr Endocrinol Metab
Journal subject:
ENDOCRINOLOGIA
/
PEDIATRIA
Year:
2023
Document type:
Article
Affiliation country:
United States