Severe hypercalcemia as a form of acute lymphoblastic leukemia presentation in children

Hypercalcemia is a rare metabolic disorder in children and is potentially fatal. It has a wide differential diagnosis, including cancer. Here, we report the case of a previously healthy 3-year-old who was admitted to the emergency room with fatigue, hyporeactivity, fever and limping gait that had ev...

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Main Authors:	Martins, Andreia Luís, Moniz, Marta, Nunes, Pedro Sampaio, Abadesso, Clara, Loureiro, Helena Cristina, Duarte, Ximo, Almeida, Helena Isabel
Format:	Online
Language:	English
Published:	Associação de Medicina Intensiva Brasileira - AMIB 2015
Online Access:	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4738828/

id	pubmed-4738828
recordtype	oai_dc
spelling	pubmed-47388282016-02-11 Severe hypercalcemia as a form of acute lymphoblastic leukemia presentation in children Martins, Andreia Luís Moniz, Marta Nunes, Pedro Sampaio Abadesso, Clara Loureiro, Helena Cristina Duarte, Ximo Almeida, Helena Isabel Case Report Hypercalcemia is a rare metabolic disorder in children and is potentially fatal. It has a wide differential diagnosis, including cancer. Here, we report the case of a previously healthy 3-year-old who was admitted to the emergency room with fatigue, hyporeactivity, fever and limping gait that had evolved over 5 days and that was progressively worsening. On examination the patient was unconscious (Glasgow coma score: 8). Laboratory tests indicated severe hypercalcemia (total calcium 21.39mg/dL, ionized calcium 2.93mmol/L) and microcytic anemia. Hyperhydration was initiated, and the child was transferred to the pediatric intensive care unit. Continuous venovenous hemodiafiltration with calcium-free solution was instituted, which brought progressive normalization of serum calcium and an improved state of consciousness. Zoledronate was administered, and metabolic and infectious causes and poisoning were excluded. The bone marrow smear revealed a diagnosis of acute lymphoblastic leukemia. Hypercalcemia associated with malignancy in children is rare and occurs as a form of cancer presentation or recurrence. Continuous venovenous hemodiafiltration should be considered in situations where there is imminent risk to life. Associação de Medicina Intensiva Brasileira - AMIB 2015 /pmc/articles/PMC4738828/ /pubmed/26761480 http://dx.doi.org/10.5935/0103-507X.20150067 Text en http://creativecommons.org/licenses/by/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
repository_type	Open Access Journal
institution_category	Foreign Institution
institution	US National Center for Biotechnology Information
building	NCBI PubMed
collection	Online Access
language	English
format	Online
author	Martins, Andreia Luís Moniz, Marta Nunes, Pedro Sampaio Abadesso, Clara Loureiro, Helena Cristina Duarte, Ximo Almeida, Helena Isabel
spellingShingle	Martins, Andreia Luís Moniz, Marta Nunes, Pedro Sampaio Abadesso, Clara Loureiro, Helena Cristina Duarte, Ximo Almeida, Helena Isabel Severe hypercalcemia as a form of acute lymphoblastic leukemia presentation in children
author_facet	Martins, Andreia Luís Moniz, Marta Nunes, Pedro Sampaio Abadesso, Clara Loureiro, Helena Cristina Duarte, Ximo Almeida, Helena Isabel
author_sort	Martins, Andreia Luís
title	Severe hypercalcemia as a form of acute lymphoblastic leukemia presentation in children
title_short	Severe hypercalcemia as a form of acute lymphoblastic leukemia presentation in children
title_full	Severe hypercalcemia as a form of acute lymphoblastic leukemia presentation in children
title_fullStr	Severe hypercalcemia as a form of acute lymphoblastic leukemia presentation in children
title_full_unstemmed	Severe hypercalcemia as a form of acute lymphoblastic leukemia presentation in children
title_sort	severe hypercalcemia as a form of acute lymphoblastic leukemia presentation in children
description	Hypercalcemia is a rare metabolic disorder in children and is potentially fatal. It has a wide differential diagnosis, including cancer. Here, we report the case of a previously healthy 3-year-old who was admitted to the emergency room with fatigue, hyporeactivity, fever and limping gait that had evolved over 5 days and that was progressively worsening. On examination the patient was unconscious (Glasgow coma score: 8). Laboratory tests indicated severe hypercalcemia (total calcium 21.39mg/dL, ionized calcium 2.93mmol/L) and microcytic anemia. Hyperhydration was initiated, and the child was transferred to the pediatric intensive care unit. Continuous venovenous hemodiafiltration with calcium-free solution was instituted, which brought progressive normalization of serum calcium and an improved state of consciousness. Zoledronate was administered, and metabolic and infectious causes and poisoning were excluded. The bone marrow smear revealed a diagnosis of acute lymphoblastic leukemia. Hypercalcemia associated with malignancy in children is rare and occurs as a form of cancer presentation or recurrence. Continuous venovenous hemodiafiltration should be considered in situations where there is imminent risk to life.
publisher	Associação de Medicina Intensiva Brasileira - AMIB
publishDate	2015
url	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4738828/
_version_	1613532897354973184

Severe hypercalcemia as a form of acute lymphoblastic leukemia presentation in children

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