Metabolic
The initial goal in the treatment of hypercalcemia is to increase the urinary excretion of
calcium via intravenous fluid hydration.

Hypercalcemia can be the result of abnormal bone function (bone resorption, parathyroid
hormone [PTH] influenced), altered renal function (renal reabsorption, PTH influenced), or
inordinate gastrointestinal tract absorption (vitamin D).

Hypercalcemia is rare in children, with primary hyperparathyroidism and malignancy the
most likely etiologies in the pediatric population.
DAYS OLD

Protein load-> increased Nitrogen ->increased Ammonia

X-Linked

Ammonia increases RR, causing RESP ALKALOSIS

Tx Arginine, protein restrict, dialysis
Hypercalcemia
Urea cycle (OTC)
Organic Acidemia (Propionic Acidemia)
DAYS OLD

Elevated Ammonia but < 500

METABOLIC ACIDOSIS WITH ANION GAP

Check urine Organic Acids

Tx Protein restriction
Jaundice, Cataracts

increased risk E.COLI INFECTION

Inv - Urine REDUCING SUBSTANCES
FA oxidation (Medium Chain)
MONTHS OLD

Decreased ketones and hypoglycemia

ACIDOSIS WITHOUT KETONES
Galactosemia