İnfantlarda Görülen Kalsiyum Yüksekliğinin D Vitamini ile İlişkisi

Yıl 2018, , 813 - 819, 30.12.2018

Abdullah Yazar , Fatma Şamlıoğlu Fatih Akın , Şükrü Arslan

https://doi.org/10.31832/smj.480860

Öz

ÖZ

Amaç: Kalsiyum
yüksekliği saptanan infantlarda hiperkalsemi etiyolojisinde D vitaminin rolünün
araştırmak ve D vitamini
düzeyine etki eden faktörlerin belirlenmesidir.

Gereç ve Yöntemler: Çalışmamız Ocak-Aralık 2012 tarihleri
arasında Konya Eğitim ve
Araştırma Hastanesi Çocuk Sağlığı
ve Hastalıkları Kliniği’nde yatan kalsiyum yüksekliği (≥10mg/dl) bulunan 53
infantta gerçekleştirildi. İnfantlar Grup I (1- 6 ay) ve Grup II (7-12 ay)
olmak üzere iki gruba ayrıldı. Çalışmaya
alınan tüm bebeklerde başvuruda ve D vitamin kesildikten bir ay sonra serum kalsiyum, fosfor, alkalenfosfataz
(ALP), parathormon (PTH), 25(OH)D3 ve spot idrarda kalsiyum, kreatinin(ca/cr)
düzeyleri çalışıldı.

Bulgular: Hastaların
44’ü (%83) erkek, 9 ‘u (%17)  kız idi ve
yaş ortalaması 5,11±2,48 aydı. Sadece
anne sütü alan bebeklerde serum 25(OH)D3 düzeyi (41,48 ng/ml)ek gıda alanlara
göre daha yüksek saptandı. 400 IU/gün D vitamini preperatı kullanan 45
infant ile farklı doz  (800-1200 IU/gün)
kullanan 8 infant arasında kalsiyum, fosfor, ALP, PTH ve 25(OH)D3 düzeyleri
arasında anlamlı fark yoktu( p≥0,05). Hastaların D vitamini kesildikten sonraki
kontrollerinde 25(OH)D3
düzeyinde düşüş sağlanırken kalsiyum seviyesi aynı düzeyde seyretti. Ancak D
vitamini düşüklüğü olduğu dönemde PTH ve fosfor artışı saptandı. ALP değerleri
değişmedi. Hastaların başvuru anında ve kontrollerinde hiperkalsiüri tespit
edilmedi.

Sonuç Kalsiyum yüksekliği sıklıkla
rutin biyokimya tetkiklerinde tesadüfen fark edilen, yaygın olmayan bir
elektrolit bozukluğudur. Sebeplerinden biri de D vitamini kullanımı olmakla
beraber, çalışmamızda 1200
IU/gün ve altındaki vitamini alımının hiperkalsemi ve hiperkalsiüri ile
ilişkisinin olmadığı gösterildi.

Anahtar
Kelimeler: D vitamini, infant, kalsiyum

 

 

 

 

 

 

The
Relationship of Hypercalcemia and Vitamin D in Infants

ABSTRACT

Objective: To
investigate the role of vitamin D in the etiology of hypercalcemia in infants
with calcium elevation and to determine the factors affecting vitamin D levels.

Material and Methods: Our study
was carried out in 53 infants with high calcium levels  (≥10 mg / dl) who were hospitalized in the
pediatrics clinic of Konya Training and Research Hospital between in a one year
period. The
patients were divided into two groups as Group I (1- 6 months-old) and Group II
(7-12 months-old). Serum levels of calcium, phosphorus, alkalenephosphatase
(ALP), parathormone (PTH), 25 (OH) D3 and spot urine calcium and creatinine (ca
/ cr) levels were studied in all infants on admission and one month after
vitamin D supplementation was stopped.

Results: 44 (83%) of the patients were
male and 9 (17%) were female and the mean age was 5,11 ± 2,48 months. Serum 25
(OH) D3 levels (41.48 ng / ml) were significantly higher in infants who
received only breast milk. There were no significant
differences between 45 infants who received 400 IU / day vitamin D and 8
infants using different doses (800-1200 IU / day) in terms of calcium,
phosphorus, ALP, PTH and 25 (OH) D3 levels (p≥0.05). 25 (OH) D3
levels were decreased and calcium levels remained the same after vitamin D
supplementation was stopped. However, there was an increase in PTH and
phosphorus levels in the period when vitamin D levels were low. ALP levels
did not change. Hypercalciuria was not detected at the time of admission and
the follow-up period of the patients.

Conclusion: Calcium is
a non-widespread electrolyte disorder, which is coincidentally detected during
routine biochemical analysis. Although one of the reasons was the use of
vitamin D, it was shown in our study that vitamin D intake of 1200 IU / day and
below did not correlate with hypercalcaemia and hypercalciuria.

Keywords: vitamine D, infant, calcium

0000-0003-0733-3943

Anahtar Kelimeler

D vitamini; infant; kalsiyum

Kaynakça

• 1. McGraww-Hill. Hormones that regulate calcium metabolism. In: Murray RK, Granner DK, Mayes PA, Rodwell VW. Harper’s Biochemistry. 25 th ed. A Lange medical book: Toronto: Appleton&Lange;2000.p.567-5742. Greenbaum, LA. Electrolyte and acid-base disorders. In: Kliegman RM, Stanton BF, Geme JW, Schor NF (eds.). Nelson Textbook of Pediatrics. 20 th ed. Philadelphia: Elsevier;2016.p.346-3893. Barstow C. Electrolytes: Calcium Disorders. Review. FP Essent 2017;459:29-34. 4. Jalbert M, Mignot A, Gauchez AS, Dobrokhotov AC, Fourcade J.Severe hypercalcemia of unusual cause, looking for the culprit: Case report and review of the literature. Nephrol Ther 2018;14(4):231-236.5. Tebben PJ, Singh RJ, Kumar R. Vitamin D-Mediated Hypercalcemia: Mechanisms, Diagnosis, and Treatment. Endocr Rev 2016;37(5):521-547.6. Wagner CL, Greer FR; American Academy of Pediatrics Section on Breastfeeding; American Academy of Pediatrics Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics 2008;122(5):1142-1152.7. Sönmez F, Akçanal B, Altincik A, Yenisey C. Urinary calcium excretion in healthy Turkish children. Int Urol Nephrol. 2007;39(3):917-922. 8. Ozkan B, Hatun S, Bereket A. Vitamin D intoxication. Review. Turk J Pediatr. 2012;54(2):93-8. 9. Neyzi O, Furman A, Bundak R, et al. Growth references for Turkish children aged 6 to 18 years.Acta Paediatr 2006;95(12):1635-1641.10. Ultraviolet light: a hazard to children. American Academy of Pediatrics. Committee on Environmental Health. Pediatrics. 1999;104(2 Pt 1):328-333.11. Gartner LM, Morton J, Lawrence RA, Naylor AJ, O'Hare D, Schanler RJ, Eidelman AI; American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2005;115(2):496-506.12. Toprak DG, Hatun Ş. Sürekli Tıp Eğitimi Dergisi. Günümüzde D Vitamini Yetersizliği ve D vitamini eksikliği Hususunda Pratisyen Hekimlerin Tutumları, 2002; 13: 16-1813. Root AW, Diamond FB. Calcium metabolism. In Sperling MA, editor. Sperling Pediatric Endocrinology 2 nd ed. Philadelphia: Saunders Press; 2002.p.65–95.14. Pehlivan I, Hatun S, Aydogan M, Babaoğlu K, Gökalp AS. Maternal vitamin D deficiency and vitamin D supplementation in healthy infants. Turk J Pediatr 2003;45:315-320.15. Bucak İH, Almış H. The Retrospective Analysis of Vitamin D Levels of Pediatric Patients in a Small City Center. Sakarya Med J 2016;6(3):136-14316. Gültekin A, Savaş A. ve Özalp D. 0-3 yaş grubunda raşitizmin görülme sıklığı, Çocuk Sağlığı ve Hastalıkları Derg.1998;528:19-25.17. Andiran N, Yordam N, Ozön A. Risk factors for vitamin D deficiency in breast-fed newborns and their mothers. Nutrition. 2002;18(1):47-50.18. Ergür AT, Berberoğlu M, Atasay B, Şıklar Z, Bilir P, Arsan S, et al. Vitamin D deficiency in Turkish mothers and their neonates and in women of reproductive age. J Clin Res Pediatr Endocrinol. 2009;1(6):266-269.19. Hochberg Z, Bereket A, Davenport M, Delemarre-Van de Waal HA, De Schepper J, Levine MA, et al. European Society for Paediatric Endocrinology (ESPE) Bone Club. Consensus development for the supplementation of vitamin D in childhood and adolescence. Horm Res. 2002;58(1):39-51.20. Greer FR, Searcy JE, Levin RS, Steichen JJ, Asch PS, Tsang RC. Bone mineral content and serum 25-hydroxyvitamin D concentration in breast-fed infants with and without supplemental vitamin D. J Pediatr. 1981 May;98(5):696-701.21. Roberts CC, Chan GM, Folland D, Rayburn C, Jackson R. Adequate bone mineralization in breast-fed infants. J Pediatr. 1981 Aug;99(2):192-196.22. Greer FR, Marshall S. Bone mineral content, serum vitamin D metabolite concentrations, and ultraviolet B light exposure in infants fed human milk with and without vitamin D2 supplements. J Pediatr. 1989 Feb;114(2):204-212.23. Yurdakök M, Bilginturan N, Özsoylu, Yordan N, Coşkun T. D vitamini yetersizliğine bağlı rikets. Katkı Pediatri Dergisi 1990;11:345–386.24. Holick MF. Sunlight, vitamin D and human health. In: Holick MF, Jung EG, eds. Proceedings, Symposium on the biologic effects of light. Berlin: Walter de Gruyter & Co; 1994.p.3-15.25. Specker BL, Valanis B, Hertzberg V, Edwards N, Tsang RC. Sunshine exposure and serum 25-hydroxyvitamin D concentrations in exclusively breast-fed infants. J Pediatr. 1985;107(3):372-376.26. Webb AR, Kline L, Holick MF. Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab. 1988;67(2):373-378.27. Kruse K. Endocrine Control of Calcium and Bone Metabolism. In Brook CGD (ed). Clinical Paediatric Endocrinology 3 rd ed. Oxford: Backwell Science Ltd; 1995.p.712–743.28. Doyle DA Hyperparathyroidism. In: Kliegman RM, Stanton BF, Geme JW, Schor NF (eds.). Nelson Textbook of Pediatrics. 20 th ed. Philadelphia: Elsevier;2016.p.2694-269829. Albertazzi P, Steel SA, Purdie DW, Gurney E, Atkin SL, Robertson WS. Hyperparathyroidism in elderly osteopenic women. Maturitas. 2002;43(4):245-249.30. Langman B. Disorders of phosphorus, calcium, and vitamin D. Barratt TM, Avner ED, Harmon WE. Pediatric nephrology, Baltimore: Lipincott Williams & Wilkins;1999.p.529-40.