Reactions 1680, p24 - 2 Dec 2017 hypercalcaemia and severe bilateral nephrocalcinosis. As his hypercalcaemia became unmanageable, he was transferred to Alfacalcidol/calcium-gluconate/ another hospital in UK. The standard dose of alfacalcidol was teriparatide not normalizing the calcium level without worsening hypercalciuria (Ur Ca:Cr 0.7–3.9 mmol/mmol). Then, he Hypercalciuria and off license use of teriparatide: received SC teriparatide injection 0.4 µg/kg twice-daily as off- 3 case reports license use. Subsequently, his hypercalciuria was resolved In a retrospective case series, 2 male infants of 2 months and without any progression in nephrocalcinosis [not all reaction’s one male child of 2 years, were described, who developed outcomes stated]. hypercalciuria during treatment with alfacalcidol and calcium Author comment: "[H]istorically it has been important to gluconate [not all routes and dosages stated]. Two of these maintain the cCa of these patients below the normal range patients received teriparatide as off-license use to normalise (between 1.9 and 2.2 mmol/L), and frequently monitor cCa the calcium level. and urinary calcium creatinine ratio (Ur Ca:Cr), along with Case 1: A 2 month-old male infant developed hypercalciuria responsive dose changes to prevent both under-treatment during treatment with alfacalcidol and calcium gluconate. He (resulting in symptomatic hypocalcaemia) and over-treatment had a diagnosis of hypoparathyroidism (HPT) due to (resulting in potential for hypercalciuria and homozygous GCMB2 (glial cell missing b 2) mutation. For nephrocalcinosis)." maintaining his serum corrected calcium (cCa), he received alfacalcidol 400ng (80 ng/kg) daily along with calcium Chinoy A, et al. Impact of intercurrent illness on calcium homeostasis in children with hypoparathyroidism: A case series. Endocrine Connections 6: 589-594, No. 8, supplements [specific drug not stated]. At the time of Nov 2017. Available from: URL: http://doi.org/10.1530/EC-17-0234 - United diagnosis, he had a PTH level of <0.6 pmol/L. Additionally, he Kingdom 803285245 developed a bronchiolitis, caused by rhinovirus and para- influenzae virus type 2. On day 4, his serum cCa was depleted with the development of a hypocalcaemic seizure. This was managed with the IV calcium gluconate. He received it as a boluses 0.11 mmol/kg, followed by an infusion 1–2 mmol/kg/day. On the subsequent 12 days, his alfacalcidol dose was increased to 1500ng (300 ng/kg) daily and calcium supplements increased to 48 mmol (10 mmol/kg, 400 mg/kg) daily. In spite of corrective measures, cCa level remained suboptimal. However, he developed hypercalciuria. At that time, his urinary calcium creatinine ratio (Ur Ca:Cr) was 2.05 mmol/mmol and cCa was >1.9 mmol/L. In view of his clinical condition, he was treated with SC teriparatide injections 0.4 µg/kg twice-daily on off-license basis. Within 7 days, his alfacalcidol and calcium supplements were discontinued and within 12 days, he was discharged from the hospital. Hypercalciuria was also improved with Ur Ca:Cr of 0.74 mmol/mmol. Case 2: A 2 month-old male infant developed hypercalciuria during treatment with alfacalcidol and calcium gluconate. He had a diagnosis of hypoparathyroidism (HPT) due to GCMB2 (glial cell missing b 2) mutation. He received alfacalcidol 400ng (110 ng/kg) daily. At the time of diagnosis, he had a PTH level of <0.6 pmol/L. Additionally, he developed a bronchiolitis caused by respiratory syncytial virus and rhinovirus. In spite of therapy, his serum cCa was depleted with the development of a hypocalcaemic seizure. At that time, his received IV calcium gluconate as bolus and infusion, and alfacalcidol dose was increased to 1500ng (400 ng/kg) daily. Oral calcium supplement [specific drug not stated] dose was also increased. After 11 days of hospitalisation, bronchiolitis resolved with the improvement in cCa level. Subsequently, he was discharged with alfacalcidol 1200ng and oral calcium supplement. After one month, his relevant investigation showed hypercalcaemia with cCa 2.74 mmol/L and hypercalciuria Ur Ca:Cr ratio 1.40 mmol/mmol. In view of his HPT and association with hypercalciuria, the borderline hypercalcaemia was considered as significant. Subsequently, oral calcium supplementation was discontinued and his alfacalcidol dose was reduced to 200ng (55 ng/kg) daily [outcomes of the reactions not stated]. Case 3: A 2 year-old male child developed hypercalciuria during treatment with alfacalcidol and calcium gluconate. At the age of 2 months, he had a diagnosis of hypoparathyroidism secondary to Sanjad-Sakati syndrome due to the genetic mutation in TBCE (tubulin-specific chaperone E) gene. His condition was stable with standard doses of alfacalcidol. At the time of diagnosis, he had a PTH level of <0.6 pmol/L. He already developed signs of nephrocalcinosis. At that time, he presented with viral gastroenteritis and hypocalcaemic seizures in Saudi Arabia. To maintain his cCa level, he received alfacalcidol in an increased dose of 3000 ng/day. Thereafter, he became lost to follow-up for an 18 month duration. Then, at the age of 2 years, he presented again with symptomatic 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
It’s your single place to instantly
discover and read the research
that matters to you.
Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.
All for just $49/month
Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly
Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.
Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.
Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.
All the latest content is available, no embargo periods.
“Hi guys, I cannot tell you how much I love this resource. Incredible. I really believe you've hit the nail on the head with this site in regards to solving the research-purchase issue.”Daniel C.
“Whoa! It’s like Spotify but for academic articles.”@Phil_Robichaud
“I must say, @deepdyve is a fabulous solution to the independent researcher's problem of #access to #information.”@deepthiw
“My last article couldn't be possible without the platform @deepdyve that makes journal papers cheaper.”@JoseServera