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Hypercalcemia-induced pancreatitis in a 4-year-old is a rare but important clinical scenario, requiring prompt diagnosis and management. Here's an overview tailored to pediatric patients:

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⚠️ Clinical Scenario Overview

A 4-year-old presents with:

• Abdominal pain (often epigastric), nausea, vomiting

• Possible fever

• Lethargy, dehydration

• Signs of pancreatitis on labs/imaging
  AND

• Elevated serum calcium levels

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🔍 Etiology of Hypercalcemia in Children

In a child this age, causes of hypercalcemia include:

1. Hyperparathyroidism (very rare in this age group)

2. Malignancy (e.g., leukemia, lymphoma → PTHrP secretion)

3. Vitamin D intoxication

4. Granulomatous diseases (sarcoidosis, TB)

5. Genetic disorders (e.g., Williams syndrome, familial hypocalciuric hypercalcemia)

6. Immobilization

7. Medications (e.g., thiazides)

8. Endocrine causes (thyrotoxicosis, adrenal insufficiency)

In children, vitamin D overdose and malignancy are more common causes than primary hyperparathyroidism.

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🧪 Diagnostic Workup

For a child with pancreatitis + hypercalcemia, assess:

• Serum calcium (total and ionized)

• PTH (to distinguish PTH-dependent vs independent)

• Vitamin D levels (25-hydroxy and 1,25-dihydroxy)

• PTHrP (if malignancy suspected)

• Renal function

• Amylase/lipase

• Abdominal ultrasound or CT to confirm pancreatitis

• Urinary calcium/creatinine ratio

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🧠 Pathophysiology

Hypercalcemia leads to pancreatitis via:

• Increased activation of trypsinogen within the pancreas

• Calcium deposition in pancreatic ducts

• Ischemia due to vasoconstriction

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🩺 Management Principles

1. Treat Pancreatitis Supportively

• NPO, IV fluids, analgesia

• Monitor for complications (e.g., pseudocysts, necrosis)

2. Correct Hypercalcemia

• IV hydration (normal saline)

• Loop diuretics (furosemide after hydration)

• Calcitonin (fast-acting but transient)

• Bisphosphonates (e.g., pamidronate) if severe or refractory

• Treat underlying cause (e.g., stop vitamin D, treat malignancy)

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📌 Summary

In a 4-year-old, hypercalcemia-induced pancreatitis is rare but serious. Vitamin D toxicity, malignancy, or genetic syndromes may be underlying causes. Early recognition and treatment of hypercalcemia are essential to prevent complications.

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