Development of hypervitaminosis A in a patient on long-term parenteral hyperalimentation

Area of Science:

• Pediatric Gastroenterology
• Clinical Nutrition
• Toxicology

Background:

• Intestinal pseudo-obstruction is a severe motility disorder requiring long-term nutritional support.
• Parenteral hyperalimentation is a life-sustaining treatment for patients with non-functional gastrointestinal tracts.
• Maintaining precise nutrient balance is critical in long-term parenteral nutrition.

Observation:

• A pediatric patient with intestinal pseudo-obstruction on parenteral hyperalimentation for one year presented with symptoms of hypervitaminosis A.
• Radiographic evidence and serum vitamin A levels, which were five times the normal range, confirmed the diagnosis.
• The patient exhibited classical signs indicative of vitamin A toxicity.

Findings:

• The diagnosis of hypervitaminosis A was confirmed through clinical signs, radiographic findings, and elevated serum vitamin A levels.
• Withdrawal of vitamin A from the parenteral hyperalimentation fluid resulted in a rapid and positive clinical response.
• This case demonstrates a direct correlation between excessive vitamin A intake via parenteral nutrition and toxicity.

Implications:

• This case underscores the critical need for vigilant monitoring of vitamin levels in patients receiving long-term parenteral hyperalimentation.
• It highlights the potential for iatrogenic vitamin A toxicity in this patient population.
• Adjusting vitamin A dosage in parenteral nutrition can effectively manage and reverse hypervitaminosis A, improving patient outcomes.