{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T04:49:12Z","timestamp":1747198152661,"version":"3.40.5"},"reference-count":8,"publisher":"Walter de Gruyter GmbH","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec id=\"j_jpem-2023-0304_abs_001\">\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Hypercalcemia has been reported as an uncommon complication of the ketogenic diet (KD). Here we present a toddler whose hypercalcemia persisted for 2\u00a0months after stopping the KD.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpem-2023-0304_abs_002\">\n                  <jats:title>Case presentation<\/jats:title>\n                  <jats:p>A 2 year 11-month-old child with global developmental delay, infantile spasms, neuromuscular weakness with limited mobility, tracheostomy and ventilator dependence, and oropharyngeal dysphagia with G-tube dependence presented with hypercalcemia in the setting of recurrent vomiting. At presentation, the patient was adherent to a KD and taking topiramate since infancy for intractable seizures. His laboratory parameters at presentation showed hypercalcemia (11.9\u202fmg\/dL), hypercalciuria, acute renal failure, low alkaline phosphatase (76\u202fIU\/L [110\u2013302\u202fIU\/L]), parathyroid hormone (PTH) &lt;6\u202fpg\/mL (18\u201380\u202fpg\/mL), normal thyroid function, cortisol and vitamin D level. The patient\u2019s hypercalcemia persisted post-discontinuation of the KD and topiramate. PTH-related protein was mildly elevated at 15.3\u202fpmol\/L. Follow-up laboratory and imaging studies ruled out malignancy. He was managed with calcitonin 4\u202fu\/kg\/dose Q12H\u00a0\u00d7\u00a01\u00a0day and 8\u202fu\/kg\/dose Q8H\u00a0\u00d7\u00a01\u00a0day, hydration and low-calcium formula. Post-discontinuation of the KD, normalization of alkaline phosphatase levels preceded the normalization of calcium on day 55 and PTH on day 85.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpem-2023-0304_abs_003\">\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Hypercalcemia may persist for an extended period after weaning from a KD; lab parameters may mimic that of hypophosphatasia as previously described in the literature. Normalization of alkaline phosphatase, a marker of bone turnover, indicates recovery from the adynamic state induced by the KD and typically precedes the normalization of calcium and PTH.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1515\/jpem-2023-0304","type":"journal-article","created":{"date-parts":[[2023,10,4]],"date-time":"2023-10-04T13:00:50Z","timestamp":1696424450000},"page":"1109-1113","source":"Crossref","is-referenced-by-count":2,"title":["Persistent hypercalcemia mimicking hypophosphatasia after discontinuation of a ketogenic diet: a case report"],"prefix":"10.1515","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0391-3759","authenticated-orcid":false,"given":"Sabitha","family":"Sasidharan Pillai","sequence":"first","affiliation":[{"name":"Division of Pediatric Endocrinology, Hasbro Children\u2019s Hospital , Providence , USA"},{"name":"Department of Pediatrics , The Warren Alpert Medical School of Brown University , Providence , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renee","family":"Robilliard","sequence":"additional","affiliation":[{"name":"Division of Pediatric Endocrinology, Hasbro Children\u2019s Hospital , Providence , USA"},{"name":"Department of Pediatrics , The Warren Alpert Medical School of Brown University , Providence , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meghan E.","family":"Fredette","sequence":"additional","affiliation":[{"name":"Division of Pediatric Endocrinology, Hasbro Children\u2019s Hospital , Providence , USA"},{"name":"Department of Pediatrics , The Warren Alpert Medical School of Brown University , Providence , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monica","family":"Serrano-Gonzalez","sequence":"additional","affiliation":[{"name":"Division of Pediatric Endocrinology, Hasbro Children\u2019s Hospital , Providence , USA"},{"name":"Department of Pediatrics , The Warren Alpert Medical School of Brown University , Providence , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7886-9871","authenticated-orcid":false,"given":"Kevin J.","family":"Scully","sequence":"additional","affiliation":[{"name":"Division of Pediatric Endocrinology, Hasbro Children\u2019s Hospital , Providence , USA"},{"name":"Department of Pediatrics , The Warren Alpert Medical School of Brown University , Providence , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2023,10,5]]},"reference":[{"key":"2023111313421769107_j_jpem-2023-0304_ref_001","doi-asserted-by":"crossref","unstructured":"Hawkes, CP, Roy, SM, Dekelbab, B, Frazier, B, Grover, M, Haidet, J, et al.. Hypercalcemia in children using the ketogenic diet: a multicenter study. J\u00a0Clin Endocrinol Metab 2021;106:e485\u201395. https:\/\/doi.org\/10.1210\/clinem\/dgaa759.","DOI":"10.1210\/clinem\/dgaa759"},{"key":"2023111313421769107_j_jpem-2023-0304_ref_002","doi-asserted-by":"crossref","unstructured":"Kim, JM. Ketogenic diet: old treatment, new beginning. Clin Neurophysiol Pract 2017;2:161\u20132. https:\/\/doi.org\/10.1016\/j.cnp.2017.07.001.","DOI":"10.1016\/j.cnp.2017.07.001"},{"key":"2023111313421769107_j_jpem-2023-0304_ref_003","doi-asserted-by":"crossref","unstructured":"Lin, A, Turner, Z, Doerrer, SC, Stanfield, A, Kossoff, EH. Complications during ketogenic diet initiation: prevalence, treatment, and influence on seizure outcomes [published correction appears in Pediatr Neurol. 2018 May 9;]. 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Kidney Int Rep 2018;3:684\u201390. https:\/\/doi.org\/10.1016\/j.ekir.2018.02.005.","DOI":"10.1016\/j.ekir.2018.02.005"},{"key":"2023111313421769107_j_jpem-2023-0304_ref_006","doi-asserted-by":"crossref","unstructured":"Hawkes, CP, Levine, MA. Ketotic hypercalcemia: a case series and description of a novel entity. J Clin Endocrinol Metab 2014;99:1531\u20136. https:\/\/doi.org\/10.1210\/jc.2013-4275.","DOI":"10.1210\/jc.2013-4275"},{"key":"2023111313421769107_j_jpem-2023-0304_ref_007","doi-asserted-by":"crossref","unstructured":"Simm, PJ, Bicknell-Royle, J, Lawrie, J, Nation, J, Draffin, K, Stewart, KG, et al.. The effect of the ketogenic diet on the developing skeleton. Epilepsy Res 2017;136:62\u20136. https:\/\/doi.org\/10.1016\/j.eplepsyres.2017.07.014.","DOI":"10.1016\/j.eplepsyres.2017.07.014"},{"key":"2023111313421769107_j_jpem-2023-0304_ref_008","doi-asserted-by":"crossref","unstructured":"Garofalo, V, Barbagallo, F, Cannarella, R, Calogero, AE, La Vignera, S, Condorelli, RA. 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