Sorry to interrupt the riveting conversation about insurance reimbursement & pp rates;-) But I need help! I got a couple responses to my post on hypercalcemia last week. Here's more info:
This is MY baby I'm talking about, but I think it's an unusual case & possibly we can all learn from it so I'm posting. We have an appointment with an endocrinologist at our local Children's Hospital on Monday & I'd like to be a little more informed going into the appointment.
-Born at 36 weeks, 6 lbs 5 oz
-6.5 weeks old/42.5 weeks adjusted, approximately 10 lbs
-Last labwork was last Friday:
*serum calcium 10.4 (H)-down from 10.5 the week before
*ionized calcium 1.44 (H)-down from 1.47 the week before
*phosphorus 6.7
*urine calcium 13.9 (H)
*25 OHD (vit d) 22 (L)
*125 OHD (vit d) 133 (H)
*PTH <2.4 (L)-this # is from a couple weeks ago
Relevant medical history:
-born at birth center, transported to NICU due to respiratory distress w/ grunting & retractions, 10 days on NICU
-nasal c-pap for first 30 hours, no feeds during this time, initiated breastfeeding as soon as c-pap was d/c'd
-*D10 PLUS CALCIUM* given via IV for first 5 days of life
-jaundice, triple phototherapy, down to 12.5 by discharge, in normal range by 1 week after discharge
-I started to get sick during his NICU stay, midwife suspected kidney infection & recommended 50,000-100,000 iu vit D daily (along w high doses vit C & cranberry) for 3 days. I did do this, starting on baby's day of life 5. Probably took about 75,000iu/day of vit d.
-My PTH is also very low, 3.6, my calcium is normal at 9.something. I had d25 drawn, but haven't gotten results.
We saw a local pediatric endocrinologist who was perplexed that the hypercalcemia was persisting and recommended steroids. (Ugh!)
I have been consulting with the ped endos at Children's. Their first recommendation (other than additional labs) was, get ready, low calcium formula. I declined as the baby is asymptomatic, among other reasons! But I have a feeling I'm going to get the lecture again when we go in on Monday for our appointment.
It seems likely to me that the hypercalcemia may be due to my high doses of vit d supplementation combined with the baby's IV calcium. It is my understanding that hypercalcemia resulting from vit d overdose can persist for months since vit d is fat soluble. (Though it certainly could be some mysterious metabolic problem.) Both endos were pretty dismissive of this theory. The calcium specialist at Children's actually told me that vit d levels in breastmilk fluctuate very little. I referred him to Carol Wagner's work. So I'm also a little paranoid that I've already ticked him off since I've been too opinionated!
Do I *need* to treat asymptomatic hypercalcemia? If so, what are the best options? I'm not excited about steroids OR formula:-/ I know another possibility is hydration & then lasix. Would there be benefit to IV hydration over oral hydration (preserve exclusivity of breastfeeding & protect the gut perhaps?) Are there risks to not treating?
Our appointment is Monday, Aug 6. I would appreciate any help/advice/anecdotal evidence or experiences of others.
Thanks so much.
-Laura Wasielewski MS, CCC-SLP, IBCLC
Los Angeles, CA
***********************************************
Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome
|
