Vitamin D and Risk for Vitamin A Intoxication in an 18-Month-Old Boy

Abstract

An 18-month-old boy presented with abdominal pain, vomiting, diarrhea, and poor appetite for 6 days. He had been given a multivitamin preparation once daily, containing 50.000 IU of vitamin D and 10.000 IU of vitamin A for a wide anterior fontanelle for about three months. He presented with hypercalcemia, low levels of parathyroid hormone (PTH), and very high serum 25-hydroxyvitamin D (25-OHD) levels. Renal ultrasound showed nephrocalcinosis. He did not have sign or symptom of vitamin A intoxication. Patient was successfully treated with intravenous hydration, furosemide, and prednisolone. With treatment, serum calcium returned rapidly to the normal range and serum 25-OHD levels were reduced progressively. In conclusion the diagnosis of vitamin D deficiency rickets without checking 25-OHD levels may cause redundant treatment that leads to vitamin D intoxication (VDI).

An Infant with Asymptomatic Vitamin D Intoxication: A Prolonged and Sustainable Recovery

“…Reviewing previous literature of infants with VDI (Supplement A), we postulate that variations in the duration and frequency of the overdose could lead to variability in associated symptoms due to variable hormonal responses that control vitamin D metabolism. In previous reports, infants with symptomatic vitamin D intoxication had received daily large doses (50,000-200,000 IU of vitamin D3) over a longer duration (1-4 months) [13,[17][18][19][20][21][22][23][24]. On the other hand, those with an asymptomatic course of illness had received relatively much smaller doses (10,000-12,000 IU of vitamin D3) over a shorter duration (less than a month) before presentation [23,24].…”

Vitamin D Intoxication and Nephrocalcinosis in a Young Breastfed Infant

“…Over-the-counter vitamin D supplements are easily and readily available [18]. e inappropriate administration of high doses of vitamin D in infants are typically provided by families for complaints such as delayed teething, late walking, and knock-knee gait [9]. Without appropriate instructions on dosing and administration, a significant risk of vitamin D toxicity exists [13,18].…”

“…Hypercalcemia and vitamin D toxicity can lead to serious complications including renal failure, hypertension, and nephrocalcinosis [17,23,24]. Medullary nephrocalcinosis can be detected by ultrasound [9]. Nephrocalcinosis is a common Case Reports in Endocrinology pathological condition, characterized by hypercalciuria and/ or hypercalcemia, with only 10% of cases caused by vitamin D intoxication [9].…”

“…Medullary nephrocalcinosis can be detected by ultrasound [9]. Nephrocalcinosis is a common Case Reports in Endocrinology pathological condition, characterized by hypercalciuria and/ or hypercalcemia, with only 10% of cases caused by vitamin D intoxication [9]. Treatment for vitamin D toxicity usually involves removal of the exogenous source, intravenous fluid hydration, diuretics, a low-calcium diet, the administration of steroids, bisphosphonate therapy, and sometimes, renal dialysis [6,[23][24][25].…”

“…Vitamin D is an essential hormone in the human body that regulates calcium homeostasis and prevents the development of rickets [6][7][8]. Vitamin D intoxication is an uncommon event that leads to hypercalcemia, which is associated with both immediate and late morbidities that can cause severe renal complications [9][10][11][12][13][14][15]. Recently, there have been several case reports of vitamin D toxicity in very young infants due to vitamin D overdose [10,12].…”