Acute vitamin D intoxication in a child
Acute vitamin D intoxication in a child
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DOI：
10.1542/peds.2004-2580
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发表时间：
2005-09-01
期刊：
影响因子：
8
通讯作者：
Nelson, LS
中科院分区：
文献类型：
--
作者：
Barrueto, F;Wang-Flores, HH;Nelson, LS
我们介绍了一个独特的病例，一名先前健康的 2 岁男孩因无意过量服用进口维生素 D 补充剂而患有抵抗性高钙血症和高血压。患者最初因绞痛和便秘而到急诊科就诊，经良性体检后出院。症状持续存在，第二次就诊时，发现患者血清钙水平为 14.4 mg/dL。尽管静脉注射正常浓度一半的 5% 葡萄糖溶液、速尿、降钙素和氢化可的松进行治疗，但住院第二天钙浓度仍增至 15.0 mg/dL，直到住院第四天才下降，降至 13.9 mg/dL。住院第 3 天，维生素 D 浓度达到峰值 470 ng/mL。经过进一步询问，这位母亲透露，她每天给儿子服用 1 安瓿拉奎弗罗（Raquiferol）（一种进口维生素 D 补充剂），而不是建议的每天 2 滴。每支安瓿含有 600 000 IU 维生素 D；因此，男孩在 4 天内总共接受了 2,400,000 国际单位。患者高钙血症持续14天，并发持续性高血压。没有发现肾脏、心脏或神经系统并发症。出院时，维生素 D 浓度仍升高至 389 ng/mL，总钙水平下降至 11 mg/dL。男孩临床完全康复。该案例强调了使用进口和/或不受监管的药物时需要谨慎，以及父母剂量错误的危险。
We present the unique case of a previously healthy, 2- year- old boy with resistant hypercalcemia and hypertension resulting from an unintentional overdose with an imported vitamin D supplement. The patient presented initially to the emergency department with colic and constipation and was discharged after a benign physical examination. The symptoms persisted and, on the second visit, the patient was found to have a serum calcium level of 14.4 mg/ dL. Despite therapy with intravenously administered 5% dextrose solution at one- half normal strength, furosemide, calcitonin, and hydrocortisone, the calcium concentration increased to 15.0 mg/ dL on the second hospital day and did not decrease until the fourth hospital day, when it fell to 13.9 mg/ dL. The vitamin D concentration peaked at 470 ng/ mL on hospital day 3. With additional questioning, the mother revealed that she had been giving her son a daily dose of 1 ampule of Raquiferol, an imported vitamin D supplement, instead of the recommended 2 drops per day. Each ampule contained 600 000 IU of vitamin D; therefore, the boy received a total of 2 400 000 IU over 4 days. The patient's hypercalcemia persisted for 14 days and was complicated by persistent hypertension. No renal, cardiac, or neurologic complications were noted. At discharge, the vitamin D concentration was still elevated at 389 ng/ mL and the total calcium level had decreased to 11 mg/ dL. The boy made a complete clinical recovery. This case highlights the need for caution when using imported and/ or unregulated medicines, as well as the dangers of parental dosing errors.