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[Hydrocephalus during central parenteral feeding. Role of vitamin A poisoning]
Insights
Vitamin A intoxication can cause hydrocephalus in children receiving parenteral nutrition. Early detection and dose adjustment are crucial for managing this serious complication.
Area of Science:
- Pediatric Nutrition
- Clinical Toxicology
- Neurology
Background:
- Central parenteral nutrition (CPN) is a critical intervention for children unable to receive nutrition orally.
- Hydrocephalus, an abnormal accumulation of cerebrospinal fluid in the brain, can occur in pediatric patients.
- Vitamin A is essential but can be toxic in excessive amounts, particularly during nutritional rehabilitation.
Observation:
- Five pediatric cases of hydrocephalus were observed during the renutrition phase of CPN, unrelated to other neurological conditions.
- Two of these cases were definitively linked to vitamin A intoxication due to high-dose, water-soluble vitamin A administration.
- Three additional hydrocephalus cases during CPN were associated with jugular thrombosis or rapid weight recovery in marasmus.
Findings:
- Elevated plasma retinol and transport complex levels confirmed vitamin A toxicity in two patients.
- The administered vitamin A doses (1,500 and 3,000 micrograms retinol equivalent) exceeded recommended levels for CPN.
- Hydrocephalus developed between the 6th and 16th day of refeeding, indicating a potential link to the nutritional intervention.
Implications:
- This study highlights the risk of vitamin A toxicity and subsequent hydrocephalus in pediatric patients undergoing CPN.
- Careful monitoring of vitamin A levels and appropriate dosage adjustments are essential during CPN.
- Understanding these risks can help prevent severe neurological complications in vulnerable pediatric populations.
Abstract:
Five children receiving central parenteral nutrition presented between the 6th and 16th day of renutrition with hydrocephalus unrelated to intercurrent neurologic disorder. Repeated determinations of plasma retinol and of the transport complex components made the proof of vitamin A intoxication in 2 cases. Vitamin A had been provided in the form of a water-soluble vitamin-solution incorporated in the nutrition mixture (doses: 1,500 micrograms and 3,000 micrograms retinol equivalent respectively). These 2 case reports have to be compared with 3 other cases of hydrocephalus occurring during total parenteral nutrition. One child presented with bilateral jugular thrombosis secondary to percutaneous venous approach trials, while the 2 other were probably within the framework of an accelerated weight recovery following nutritional marasmus.