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Hypercalcaemia may occur years after initiating ketogenic diet in children

3 days ago

Children starting the ketogenic diet, particularly in the setting of renal impairment, are at risk of developing ketotic hypercalcaemia in subsequent years, suggests a study.

“The mechanism is unknown but appears to be due to reduced osteoblast activity and impaired bone formation,” the investigators said. “We recommend close attention to optimizing bone health in these children, and screening for the development of ketotic hypercalcaemia.”

This multicentre case series was conducted to describe the clinical characteristics of acute hypercalcaemia in children on the ketogenic diet by analysing the presentation, response to treatment, and natural history in a large cohort of patients.

Fourteen children (median age, 6.3 years) who developed acute hypercalcaemia 2.1 years (range, 0.2–12) after starting the ketogenic diet were enrolled. The investigators then collected information on clinical presentation, treatment, and course of complication.

All participants had low levels of parathyroid hormone. Levels of 1,25-dihydroxyvitamin D were also low except in one child. Seven children (50 percent) had impaired renal function at presentation and 12 had low alkaline phosphatase levels for age.

Normocalcaemia was achieved, but two patients had hypercalcaemia recurrence over observation up to 9.8 years. One child discontinued the ketogenic diet prior to achieving normocalcaemia, while four more stopped the diet during follow-up after resolution of hypercalcaemia.

“The ketogenic diet is associated with progressive skeletal demineralization, hypercalciuria, and nephrolithiasis,” the investigators said. “Acute hypercalcaemia has been described as a newly recognized complication of this treatment.”

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Most Read Articles
01 Dec 2020
Tetanus toxoid 5 Lf, diphtheria toxoid 2 Lf, pertussis toxoid 2.5 mcg, filamentous haemagglutinin 5 mcg, fimbriae types 2 and 3 5 mcg, pertactin 3 mcg
Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021
Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.
18 Feb 2021
Treatment with tanezumab appears to relieve pain and improve physical function in patients with hip or knee osteoarthritis (OA), but may lead to dose-dependent increase in joint safety events as compared with nonsteroidal anti-inflammatory drug (NSAID), according to the results of a phase III safety trial.
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