A Framework for Approaching Refractory Hypocalcemia in Children

A 10-year-old girl presented to our institution for evaluation of refractory hypocalcemia. About 36 hours prior, the patient had been admitted to another hospital for nausea and vomiting in the setting of recent urinary tract infection with urticarial rash. She was found to be hypocalcemic, with a serum calcium level of 6.4 mg/dL (normal range, 9.6–10.6 mg/dL). The hypocalcemia she had resisted treatment with intravenous (IV) calcium gluconate at a dose of 2 g every 6 hours, with her levels remaining between 6.3 and 7.1 mg/dL. After 24 hours of treatment with no improvement in calcium levels,

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