Category: Pediatrics
Keywords: pediatrics, electrolytes, hypercalcemia, calcium (PubMed Search)
Posted: 6/12/2026 by Kathleen Stephanos, MD
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Bottom Line: In pediatric patients, identifying the underlying etiology of hypercalcemia is essential to guide appropriate long-term management.
Etiology: The causes of hypercalcemia in children are diverse and are broadly classified into parathyroid hormone (PTH)-mediated and non–PTH-mediated categories. Non–PTH-mediated causes include endocrine disorders, inborn errors of metabolism, medication-induced hypercalcemia, granulomatous diseases, immobilization, and malignancy.
Clinical Presentation: Symptoms vary depending on the severity of hypercalcemia. Mild hypercalcemia may be asymptomatic or present with findings such as shortened QT interval, polyuria, and constipation. Severe hypercalcemia can lead to significant complications, including seizures, altered mental status (e.g., hallucinations), dehydration, cardiac dysrhythmias, abdominal pain, and pancreatitis.
Management: In the emergency setting, the primary treatment is intravenous hydration, typically with 0.9% saline, to cause calcium dilution and increased urinary excretion of calcium. Loop diuretics should be used with caution in pediatric patients due to the risk of exacerbating dehydration. Additional pharmacologic therapies, including calcitonin, bisphosphonates, and glucocorticoids, may be indicated depending on the etiology and severity, and should be administered in consultation with a nephrologist and/or endocrinologist. In patients with contraindications to aggressive fluid management (e.g., renal or cardiac dysfunction), or in cases of severe, life-threatening hypercalcemia, dialysis may be required.
Zieg J, Ghose S, Raina R. Electrolyte disorders related emergencies in children. BMC Nephrol. 2024 Aug 30;25(1):282.
