Severe Hypercalcemia in an Adolescent with New-Onset Diabetes Mellitus and Diabetic Ketoacidosis

Severe hypercalcemia in diabetic ketoacidosis (DKA) among children is rare and can be life-threatening. Its exact etiology is not clear and several mechanisms related to dehydration and metabolic acidosis have been proposed. Rigorous hydration with the correct fluid choice usually corrects the hypercalcemia in those without other underlying causes of hypercalcemia such as hyperparathyroidism. Specific medications to treat the hypercalcemia may be avoided. We present a 13-year-old girl with new type 1 onset diabetes mellitus in DKA with unusually severe and persistent hypercalcemia and severe hypernatremia that gradually responded to rigorous intravenous hydration with Plasmalyte A (Baxter International Inc., Deerfield, Illinois).