ArticleThe Journal of clinical endocrinology and metabolism2021
Hypercalcemia in Children Using the Ketogenic Diet: A Multicenter Study.
Article in The Journal of clinical endocrinology and metabolism, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 24 citations in OpenAlex.
- Article
- Treatment of pediatric epilepsy.Pediatric investigation · 2026Review
- Ketogenic diet in neonates: effects, pitfalls, and a paradigm from a preterm newborn affected by pyruvate dehydrogenase deficiency.Journal of perinatology : official journal of the California Perinatal Association · 2025Review
- Favorable response to ketogenic diet therapy in a patient withEpilepsy & behavior reports · 2025Article
- Acute Changes in Liver Function Tests During Initiation of Ketogenic Diet.Journal of child neurology · 2024Article
- Breaking the Cycle of Recurrent Calcium Stone Disease.Advances in kidney disease and health · 2023Review
- The effects of popular diets on bone health in the past decade: a narrative review.Frontiers in endocrinology · 2023Review
- Molecular mechanisms altering tubular calcium reabsorption.Pediatric nephrology (Berlin, Germany) · 2022Review
- Fad Diets: Facts and Fiction.Frontiers in nutrition · 2022Review
- A Novel Germline Mutation ofInternational journal of molecular sciences · 2021Article
- Incidence and Characteristics of Kidney Stones in Patients on Ketogenic Diet: A Systematic Review and Meta-Analysis.Diseases (Basel, Switzerland) · 2021Article
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Authors and funding
13 authors at 11 institutions in 2 countries.
Funding
Abstract
contextThe ketogenic diet is associated with progressive skeletal demineralization, hypercalciuria, and nephrolithiasis. Acute hypercalcemia has been described as a newly recognized complication of this treatment.
objectiveTo describe the clinical characteristics of acute hypercalcemia in children on the ketogenic diet through analysis of the presentation, response to treatment, and natural history in a large cohort of patients.
designA multicenter case series was performed including children who developed acute hypercalcemia while treated with the ketogenic diet. Information on clinical presentation, treatment, and course of this complication was collated centrally.
resultsThere were 14 patients (median (range) age 6.3 (0.9 to 18) years) who developed hypercalcemia 2.1 (range, 0.2-12) years after starting the ketogenic diet. All had low levels of parathyroid hormone and levels of 1,25-dihydroxyvitamin D were low in all except one. Seven (50%) had impaired renal function at presentation. All except the 2 oldest had low alkaline phosphatase levels for age. Once normocalcemia was achieved, hypercalcemia recurred in only 2 of these patients over observation of up to 9.8 years. One patient discontinued the ketogenic diet prior to achieving normocalcemia while 4 more stopped the diet during follow-up after resolution of hypercalcemia.
conclusionsKetotic hypercalcemia can occur years after starting the ketogenic diet, especially in the setting of renal impairment. The mechanism is unknown but appears to be due to reduced osteoblast activity and impaired bone formation. We recommend close attention to optimizing bone health in these children, and screening for the development of ketotic hypercalcemia.
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