• Katherine G Doyle, Mercedes M Blackstone, and Brett C Barrett.
• From the Department of Pediatrics, Children's Hospital of Philadelphia.
• Pediatr Emerg Care. 2021 Aug 1; 37 (8): e479e482e479-e482.

AbstractWe present a case of a 20-month-old girl who presented to the emergency department with anorexia, progressive weakness, and lethargy who was found to have severe hypercalcemia (20.7 mg/dL) and vitamin D hypervitaminosis. Further questioning revealed that this was secondary to a subacute toxic ingestion of "L'il Critters" calcium and vitamin D3 gummy vitamins that were being administered by the patient's mother multiple times a day for several weeks or even months. This occurred in the setting of child neglect due to the mother's mental illness. The patient required intensive care unit admission and had a prolonged hospital course complicated by hypomagnesemia, hyperphosphatemia, weight loss, and persistent weakness. Her hypercalcemia was initially refractory to standard treatment of intravenous fluids, prednisone, multiple trials of calcitonin, and zoledronic acid. Our patient had the highest calcium level we are aware of in a toddler and is the only case we know of that occurred as a result of a prolonged, intentional exposure in the setting of child neglect and a complex social situation. This case reviews the causes and management of hypercalcemia and vitamin D intoxication. It also highlights the need for a comprehensive social history and exposes the vulnerabilities of children living in homes afflicted by parental depression and severe mental illness.Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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