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Concomitant Hypercalcemia and Hyperammonemia Associated With Distal Renal Tubular Acidosis

Saini, Arun MD*; Karmakar, Swati A. MD*; Kannikeswaran, Nirupama MD*†

doi: 10.1097/PEC.0b013e31824957cb
Illustrative Cases

We describe an infant with concomitant hypercalcemia and hyperammonemia associated with nonanion gap metabolic acidosis secondary to distal renal tubular acidosis (dRTA). The levels of both serum calcium and ammonia rapidly normalized with the correction of dehydration and metabolic acidosis. To the best of our knowledge, there has been only one previous case report of concomitant hypercalcemia and hyperammonemia associated with dRTA that has been reported in the literature. We describe the causes and emergent management of hypercalcemia and review the possible mechanisms of this rare association with dRTA.

From the *Carmen and Ann Adams Department of Pediatrics and †Division of Emergency Medicine, Children’s Hospital of Michigan, Wayne State University, Detroit, MI.

Disclosure: The authors declare no conflict of interest.

Reprints: Arun Saini, MD, Carman and Ann Adams Department of Pediatrics, Children’s Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201 (e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.