Symptoms and Clinical Manifestations of Hypercalcemia in Children

Hypercalcemia, clinically defined as a serum calcium level exceeding 2.75 mmol/L, is a significant metabolic disturbance that can affect multiple organ systems in children. While mild cases may go unnoticed, more pronounced elevations often lead to a range of systemic symptoms. Early recognition of these signs is crucial for timely diagnosis and effective management.

Neurological and Behavioral Symptoms

One of the most common manifestations of hypercalcemia in pediatric patients involves the central nervous system. Children may exhibit persistent fatigue, lethargy, and decreased mental alertness. In more severe cases, this can progress to confusion, irritability, or even stupor. Parents might notice their child becoming unusually withdrawn, less responsive, or showing a decline in school performance due to cognitive slowing.

Cardiovascular Effects

Elevated calcium levels can significantly impact heart function. Pediatric hypercalcemia is frequently associated with increased blood pressure and disturbances in cardiac rhythm. Electrocardiographic (ECG) changes such as shortened QT intervals are common, and in rare instances, life-threatening arrhythmias may develop. These cardiovascular complications underscore the importance of monitoring heart health in affected children.

Digestive System Involvement

Gastrointestinal symptoms are among the earliest indicators of high calcium levels. Children may experience nausea, vomiting, abdominal discomfort, bloating, and constipation. The reduced gastrointestinal motility caused by hypercalcemia can mimic other digestive disorders, leading to potential misdiagnosis if serum calcium levels are not evaluated. Chronic cases may result in poor appetite and unintended weight loss.

Endocrine and Metabolic Disruptions

Hypercalcemia is often linked to underlying endocrine imbalances. In some children, it may be associated with conditions like hyperparathyroidism or thyroid dysfunction, including hyperthyroidism. These hormonal irregularities can further exacerbate calcium metabolism issues, creating a complex clinical picture that requires thorough endocrine evaluation.

Urinary Tract and Renal Complications

The kidneys are particularly vulnerable in cases of prolonged hypercalcemia. Excess calcium can deposit in renal tissues and urinary tract structures, leading to nephrocalcinosis and the formation of kidney stones. Children may develop calcium-based calculi in the kidneys, ureters, or bladder, which can cause flank pain, hematuria, and recurrent urinary tract infections. Left untreated, this can impair kidney function over time.