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Case report of acute vitamin D intoxication in an infant
Insights
Vitamin D intoxication in an infant, caused by excessive supplementation, was successfully treated. Prompt intervention with triple therapy prevented adverse effects, normalizing vitamin D levels.
Area of Science:
- Pediatrics
- Endocrinology
- Toxicology
Background:
- Vitamin D intoxication is a rare but serious condition linked to hypercalcemia and hyperphosphatemia.
- Excessive vitamin D intake can lead to severe health complications.
Observation:
- A 1.5-month-old infant received approximately 200,000 IU of vitamin D3 over one month due to maternal error.
- Initial assessment revealed elevated serum 25-hydroxyvitamin D (>400 nmol/L) and calcium (2.72 mmol/L), with suppressed PTH (6.6 pg/ml) and a high urinary calcium/creatinine ratio (1.6).
Findings:
- Treatment involved discontinuing vitamin D, encouraging fluid intake, and administering prednisolone, phenobarbitone, and furosemide for 2-4 months.
- This therapeutic regimen led to the complete normalization of laboratory markers for vitamin D toxicity.
Implications:
- Early diagnosis and appropriate management, including a triple therapy approach, are crucial for preventing adverse outcomes in acute vitamin D intoxication.
- This case highlights the importance of accurate vitamin D dosing and monitoring in infants.
Introduction:
Vitamin D intoxication represents a rare and potentially serious pathological condition caused by the excess of calcium and phosphorus. We are presenting an infant with vitamin D intoxication due to excessive daily administration, as well as therapeutic procedures that prevented its adverse effects.
Case Outline:
A 1.5-month-old female infant, born at term, exclusively breastfed and without any complaints and abnormalities of physical findings, was observed due to the data that during the preceding month, by her mother's mistake, she had received about 200,000 IU of vitamin D3. Laboratory analyses showed a high serum level of 25(OH)D (>400 nmol/L) and calcium (2.72 mmol/L), lowered PTH (6.6 pg/ml) and high urinary calcium/creatinine ratio (1.6), while other findings, including urotract ultrasonography image, were within normal limits. Treatment based on the discontinuation of vitamin D administration, infant's forced water intake, as well as the application of 2-month prednisolone and 4-month phenobarbitone and furosemide, resulted in complete normalization of the laboratory indicators of vitamin D overdose, as well as the prevention of its adverse effects.
Conclusion:
By timely recognition and adequate treatment, including triple therapy with prednisolone, phenobarbitone and furosemide, adverse effects of acute vitamin D intoxication can be prevented.