Persistent hypercalcemia mimicking hypophosphatasia after discontinuation of a ketogenic diet: a case report
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Sabitha Sasidharan Pillai
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Renee Robilliard
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 (11.9 mg/dL), hypercalciuria, acute renal failure, low alkaline phosphatase (76 IU/L [110–302 IU/L]), parathyroid hormone (PTH) <6 pg/mL (18–80 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 15.3 pmol/L. Follow-up laboratory and imaging studies ruled out malignancy. He was managed with calcitonin 4 u/kg/dose Q12H × 1 day and 8 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.
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Research ethics: Not applicable.
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Informed consent: Obtained written informed consent from the parent of the patient.
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Author contributions: SSP conceptualized the study, performed data collection and interpretation, performed literature review, and wrote the initial draft of the manuscript. KS helped to conceptualize the study, critically reviewed, and edited the manuscript. MSG, MF and RR critically reviewed and edited the manuscript. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: None.
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Research funding: None.
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Data availability: All data generated or analyzed during this study are included in this published article or in the data repositories listed in References.
References
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© 2023 Walter de Gruyter GmbH, Berlin/Boston
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Artikel in diesem Heft
- Frontmatter
- Review
- Clinical heterogeneity and therapeutic options for idiopathic infantile hypercalcemia caused by CYP24A1 pathogenic variant
- Original Articles
- Growth hormone use in pediatric inflammatory bowel disease
- Extremely and very preterm children who were born appropriate for gestational age show no differences in cortisol concentrations or diurnal rhythms compared to full-term children
- A prospective comparison study of subcutaneous and intramuscular testosterone injections in transgender male adolescents
- Excess body weight and dyslipidemia at well-child visit
- Body mass index evolution and ovarian function in adolescent girls who received GnRH agonist treatment for central precocious puberty or early and fast puberty
- Assessment of pubertal onset and disorders of puberty in Indian children and youth with type-1 diabetes
- A different approach to the evaluation of the genotype-phenotype relationship in biotinidase deficiency: repeated measurement of biotinidase enzyme activity
- Expected vs. perceived effects of gender-affirming hormone therapy among transmasculine adolescents
- Developmental scores in offspring of women with subclinical hypothyroidism in pregnancy are affected by gender and thyrotropin cutoff
- Assessment of the diagnosis, treatment, and follow-up of a group of Turkish pediatric glycogen storage disease type 1b patients with varying clinical presentations and a novel mutation
- IGAm: A novel index predicting long-term survival in patients with early-diagnosed inherited metabolic disorders
- Case Report
- Persistent hypercalcemia mimicking hypophosphatasia after discontinuation of a ketogenic diet: a case report
