scholarly journals Case of Hypercalcemia Secondary to Hypervitaminosis A in a 6-Year-Old Boy with Autism

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Arpita Kalla Vyas ◽  
Neil H. White
Keyword(s):  
Vitamin A ◽  
Case Reports ◽  
Pediatric Population ◽  
Nutritional Supplements ◽  
Hypervitaminosis A ◽  
Over The Counter ◽  
Acne Treatment

Vitamin A intoxication secondary to over-the-counter nutritional supplements and from its use in acne treatment has been described. However, there have been very few case reports of chronic hypervitaminosis A leading to hypercalcemia in the pediatric population. This paper describes a boy with hypercalcemia secondary to chronic vitamin A intoxication in the context of vitamin A usage for therapy of autism. In addition to discontinuation of vitamin A, hyperhydration, and furosemide, the hypercalcemia in this patient required the use of prednisone and pamidronate to normalize the calcium.

scholarly journals Is vitamin A consumption a risk factor for osteoporotic fracture?

2003 ◽  
Vol 62 (4) ◽  
pp. 845-850 ◽  
Author(s):  
Margo E. Barker ◽  
Aubrey Blumsohn
Keyword(s):  
Vitamin A ◽  
Mineral Content ◽  
Case Reports ◽  
Epidemiological Studies ◽  
Hypervitaminosis A ◽  
Skeletal Health ◽  
Health Studies ◽  
Habitual Intake ◽  
Bone Abnormalities

Severe vitamin A toxicity is known to have adverse effects on skeletal health. Studies involving animal models and case reports have documented that hypervitaminosis A is associated with bone resorption, hypercalcaemia and bone abnormalities. More recently, some epidemiological studies have suggested that high habitual intake of vitamin A could contribute to low bone mineral content and fracture risk. The evidence relating to the possible deleterious role of vitamin A in bone health is of variable quality and is potentially confounded by collinearity of nutrient intake and difficulties in assessing vitamin A exposure. Furthermore, because intake of vitamin A varies between studies it is not possible to define an intake threshold associated with harm.

scholarly journals The Risk of Nonsteroidal Anti-Inflammatory Drugs in Pediatric Medicine: Listen Carefully to Children with Pain

Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 1048
Author(s):  
Olivier Mboma ◽  
Stefan Wirth ◽  
Malik Aydin
Keyword(s):  
Case Reports ◽  
Pediatric Population ◽  
Kidney Injury ◽  
Over The Counter ◽  
High Daily Dose ◽  
Life Threatening ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Therapeutic Recommendation ◽  
Efficacy Profile

Over the last decades, the use of over-the-counter analgesics in the general population has increased in Germany. Ibuprofen is one of the most commonly used nonsteroidal anti-inflammatory drug (NSAID) and is frequently prescribed to children as an analgesic and/or antipyretic. Besides having a well-established safety and efficacy profile when used in appropriate doses, cases of NSAID-induced acute kidney injury (AKI) have been described in the pediatric population, particularly in the context of dehydration and in combination with other drugs. The ingestion of more than 400 mg/kg is associated with severe or life-threatening toxicity. This report is about two previously healthy adolescents, who developed AKI after taking high daily dose of ibuprofen as a pain reliever without any appropriate medical supervision. With these case reports, in addition to the side effect profiles of this analgesic, we would also like to present a certain therapeutic recommendation that we applied in these patients, and furthermore appeal to pediatricians to strictly set the indications for ibuprofen intake.

The Need to Consider Context in the Evaluation of Anti-infectious and Immunomodulatory Effects of Vitamin A and its Derivatives

2019 ◽  
Vol 20 (8) ◽  
pp. 871-878 ◽  
Author(s):  
Pedro Xavier-Elsas ◽  
Bruno M. Vieira ◽  
Daniela Masid-de-Brito ◽  
Monica G. Barradas ◽  
Maria I.C. Gaspar-Elsas
Keyword(s):  
Vitamin A ◽  
Clinical Presentation ◽  
Infectious Agents ◽  
Hypervitaminosis A ◽  
General Role ◽  
Significant Toxicity ◽  
Vast Literature ◽  
Gut Mucosa ◽  
Anti Inflammatory ◽  
Pathogen Exposure

Vitamin A and its derivatives (retinoids) act as potent regulators in many aspects of mammalian reproduction, development, repair, and maintenance of differentiated tissue functioning. Unlike other vitamins, Vitamin A and retinoids, which have hormonal actions, present significant toxicity, which plays roles in clinically relevant situations, such as hypervitaminosis A and retinoic acid ("differentiation") syndrome. Although clinical presentation is conspicuous in states of insufficient or excessive Vitamin A and retinoid concentration, equally relevant effects on host resistance to specific infectious agents, and in the general maintenance of immune homeostasis, may go unnoticed, because their expression requires either pathogen exposure or the presence of inflammatory co-morbidities. There is a vast literature on the roles played by retinoids in the maintenance of a tolerogenic, noninflammatory environment in the gut mucosa, which is considered by many investigators representative of a general role played by retinoids as anti-inflammatory hormones elsewhere. However, in the gut mucosa itself, as well as in the bone marrow and inflammatory sites, context determines whether one observes an anti-inflammatory or proinflammatory action of retinoids. Both interactions between specialized cell populations, and interactions between retinoids and other classes of mediators/regulators, such as cytokines and glucocorticoid hormones, must be considered as important factors contributing to this overall context. We review evidence from recent studies on mucosal immunity, granulocyte biology and respiratory allergy models, highlighting the relevance of these variables as well as their possible contributions to the observed outcomes.

scholarly journals CFTR Modulator Therapy with Lumacaftor/Ivacaftor Alters Plasma Concentrations of Lipid-Soluble Vitamins A and E in Patients with Cystic Fibrosis

Antioxidants ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 483
Author(s):  
Olaf Sommerburg ◽  
Susanne Hämmerling ◽  
S. Philipp Schneider ◽  
Jürgen Okun ◽  
Claus-Dieter Langhans ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Vitamin E ◽  
Vitamin A ◽  
Clinical Chemistry ◽  
Pancreatic Insufficiency ◽  
Plasma Concentrations ◽  
Plasma Vitamin ◽  
Hypervitaminosis A ◽  
Cholesterol Ratio ◽  
Fat Soluble Vitamins

Rationale: Cystic fibrosis (CF), caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene, leads to impaired pancreatic function and therefore reduced intestinal absorption of lipids and fat-soluble vitamins especially in patients with CF developing pancreatic insufficiency (PI). Previous studies showed that CFTR modulator therapy with lumacaftor-ivacaftor (LUM/IVA) in Phe508del-homozygous patients with CF results in improvement of pulmonary disease and thriving. However, the effects of LUM/IVA on plasma concentration of the lipid soluble vitamins A and E remain unknown. Objectives: To investigate the course of plasma vitamin A and E in patients with CF under LUM/IVA therapy. Methods: Data from annual follow-up examinations of patients with CF were obtained to assess clinical outcomes including pulmonary function status, body mass index (BMI), and clinical chemistry as well as fat-soluble vitamins in Phe508del-homozygous CF patients before initiation and during LUM/IVA therapy. Results: Patients with CF receiving LUM/IVA improved substantially, including improvement in pulmonary inflammation, associated with a decrease in blood immunoglobulin G (IgG) from 9.4 to 8.2 g/L after two years (p < 0.001). During the same time, plasma vitamin A increased significantly from 1.2 to 1.6 µmol/L (p < 0.05), however, levels above the upper limit of normal were not detected in any of the patients. In contrast, plasma vitamin E as vitamin E/cholesterol ratio decreased moderately over the same time from 6.2 to 5.5 µmol/L (p < 0.01). Conclusions: CFTR modulator therapy with LUM/IVA alters concentrations of vitamins A and vitamin E in plasma. The increase of vitamin A must be monitored critically to avoid hypervitaminosis A in patients with CF.

scholarly journals South African preschool children habitually consuming sheep liver and exposed to vitamin A supplementation and fortification have hypervitaminotic A liver stores: a cohort study

2019 ◽  
Vol 110 (1) ◽  
pp. 91-101 ◽  
Author(s):  
Martha E van Stuijvenberg ◽  
Muhammad A Dhansay ◽  
Jana Nel ◽  
Devika Suri ◽  
Michael Grahn ◽  
...  
Keyword(s):  
South Africa ◽  
Preschool Children ◽  
Vitamin A ◽  
Total Serum ◽  
High Dose ◽  
Serum Retinol ◽  
Hypervitaminosis A ◽  
Total Liver ◽  
Before And After ◽  
Retinyl Esters

ABSTRACT Background In some regions, multiple vitamin A (VA) interventions occur in the same target groups, which may lead to excessive stores. Retinol isotope dilution (RID) is a more sensitive technique than serum retinol to measure VA status. Objective We evaluated VA status before and after a high-dose supplement in preschool children living in a region in South Africa with habitual liver consumption and exposed to VA supplementation and fortification. Methods After baseline blood samples, subjects (46.7 ± 8.4 mo; n = 94) were administered 1.0 μmol [14,15]-13C2-retinyl acetate to estimate total liver retinol reserves by RID with a follow-up 14-d blood sample. Liver intake was assessed with a frequency questionnaire. In line with current practice, a routine 200,000 IU VA capsule was administered after the RID test. RID was repeated 1 mo later. Serum retinyl esters were evaluated using ultra-performance liquid chromatography. Results At baseline, 63.6% of these children had hypervitaminosis A defined as total liver retinol reserves ≥1.0 μmol/g liver, which increased to 71.6% after supplementation (1.13 ± 0.43 to 1.29 ± 0.46 μmol/g; P < 0.001). Total serum VA as retinyl esters was elevated in 4.8% and 6.1% of children before and after supplementation. The odds of having hypervitaminosis A at baseline were higher in children consuming liver ≥1/mo (ratio 3.70 [95% CI: 1.08, 12.6]) and in children receiving 2 (4.28 [1.03, 17.9]) or 3 (6.45 [0.64, 65.41]) supplements in the past 12 mo. Total body stores decreased after the supplement in children in the highest quartile at baseline compared with children with lower stores, who showed an increase (P = 0.007). Conclusions In children, such as this cohort in South Africa, with adequate VA intake through diet, and overlapping VA fortification and supplementation, preschool VA capsule distribution should be re-evaluated. This trial was registered at https://clinicaltrials.gov/ct2/show/NCT02915731 as NCT02915731.

VITAMIN A POISONING

PEDIATRICS ◽  
1951 ◽  
Vol 7 (3) ◽  
pp. 372-385
Author(s):  
DONALD GRIBETZ ◽  
SAMUEL H. SILVERMAN ◽  
ALBERT E. SOBEL
Keyword(s):  
Vitamin A ◽  
Experimental Studies ◽  
Plasma Vitamin ◽  
Hypervitaminosis A ◽  
Total Vitamin ◽  
Toxic Factor ◽  
Vitamin Intake ◽  
First Case ◽  
Alcohol Fraction ◽  
Clinical Literature

Two cases of hypervitaminosis A have been presented together with a review of experimental and clinical literature. The first case presented the highest reported fasting plasma vitamin A level, the increase being chiefly due to a high vitamin A alcohol fraction. This elevated level of alcoholic vitamin A probably denotes large stores of vitamin A in the liver and data have been given to show that it is a better index of hypervitaminosis A than is the total vitamin A level. In addition, evidence has been presented that the toxic factor in hypervitaminosis A is the permanent elevated plasma vitamin A level. The similarity between the experimental studies in animals and the observations in the authors' first case has been shown. The important points necessary for making a diagnosis of hypervitaminosis A have been discussed and several similar conditions have been differentiated. It cannot be emphasized too strongly that excess vitamin intake may be as dangerous as a deficient intake.

scholarly journals Milk-Alkali Syndrome: An Unusual Cause of Acute Renal Failure

2003 ◽  
Vol 2 (2) ◽  
pp. 64-65
Author(s):  
Azhar Ahmad ◽  
◽  
Rodney Dathan ◽  
Keyword(s):  
Renal Failure ◽  
Calcium Carbonate ◽  
Metabolic Alkalosis ◽  
Case Reports ◽  
Symptomatic Treatment ◽  
Self Medication ◽  
H2 Receptor Antagonists ◽  
Over The Counter ◽  
Ulcer Disease

Milk–alkali syndrome is described as a triad of hypercalcaemia, metabolic alkalosis and renal impairment, resulting from the ingestion of calcium and absorbable alkali1. It was more common in the early part of the century when antacids were used for the symptomatic treatment of peptic ulcer disease. The use of antacids has since been overtaken by H2- receptor antagonists and proton pump inhibitors. More recently, there have been various case reports of milk-alkali syndrome due to the increasing use of calcium carbonate as part of the management of osteoporosis and chronic renal failure, and also the increasing availability of calcium carbonate ‘over the counter’. We describe a case of milk-alkali syndrome due to self-medication with calcium carbonate.

THE USE AND ABUSE OF VITAMIN A

PEDIATRICS ◽  
1971 ◽  
Vol 48 (4) ◽  
pp. 655-656
Author(s):  
Sumner J. Yaffe ◽  
L. J. Filer
Keyword(s):  
Vitamin A ◽  
High Potency ◽  
Over The Counter ◽  
High Concentrations

The grave risks resulting from the unrestricted sale of high concentrations of vitamin A make it imperative that an active curb, by appropriate legislation if necessary, be placed on the over-the-counter marketing of high potency vitamin A preparations. Physicians should be aware of the vitamin A content in the preparations they prescribe for their patients. They also should caution parents regarding the dangers of overdosage of this vitamin.

Nosedrops and S.I.D.S

PEDIATRICS ◽  
1991 ◽  
Vol 88 (2) ◽  
pp. 419-419
Author(s):  
GERALD B. HICKSON
Keyword(s):  
Side Effect ◽  
Case Reports ◽  
Common Side Effect ◽  
Wide Spread ◽  
Over The Counter ◽  
Ability To Act ◽  
Life Threatening ◽  
Therapeutic Doses

In Reply.— The purpose of our paper was to examine the question of safety concerning over-the-counter (OTC) release of promethazine.1 Our stated opinion, that the drug is not appropriate for OTC release, was based on more than a suggested relationship with SIDS, but also on the drug's common side effect of sedation, ability to act as a cerebral stimulant even in therapeutic doses inducing hallucinations, convulsions and encephalopathy in some children, case reports concerning promethazine use and apparent life-threatening events, the potential for families to misuse this drug due to its sedative and antiemetic properties, and most importantly, FDA standards of safety for OTC medications which require "a low potential for harm which may result from abuse under conditions of wide spread availability."2

A ‘Suntan’ in capsules - orobronze

1983 ◽  
Vol 21 (15) ◽  
pp. 57-57 ◽  
Keyword(s):  
Vitamin A ◽  
Medicinal Product ◽  
Food Additive ◽  
Over The Counter ◽  
Farmed Salmon ◽  
Naturally Occurring ◽  
Brown Colour ◽  
Healthy Activity ◽  
Product Licence

To some people a suntan is an indicator of healthy activity and social prowess. Canthaxanthin is a naturally occurring orange carotenoid without vitamin A properties made by Hoffmann-La Roche and used, for example, as a food additive to improve the colour of farmed salmon. It is now also available over the counter as 30 mg oral capsules (Orobronze - De Witt) for people to dye themselves an orange-brown colour. The DHSS has not issued a product licence for Orobronze because it is ‘not a medicinal product’.

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