title: Fanconi syndrome following bowel surgery and hepatitis reversed by 25-hydroxycholecalciferol.
abstract: A permature male infant required intravenous alimentation for six weeks following extensive surgery for ileal and cecal necrosis. At 3 months he developed evidence of hepatitis. Subsequently osteoporosis and the Fanconi syndrome appeared. Urine phosphate clearance was 83 percent of creatinine clearance at a serum phosphate concentration of 1.6 mg/dl. Concentration of plasma immunoreactive parathyroid hormone was elevated at 550 pg/ml. 25-Hydroxycholecalciferol was given at 240 mug/day. Aminoaciduria disappeared and bone healing occurred. Serum phosphate rose to 6.5 mg/dl and phosphate clearance fell to 2 percent of creatinine clearance. Upon cessation of 25-OHCC therapy, the Fanconi syndrome recurred despite administration of vitamin D2. 25-OHCC was then administered at 40 mug/day, and the urine abnormalities were reversed. The patient probably developed hyperparathyroidism, secondary malabsorption, and hepatitis. The Fanconi syndrome was the consequence of the hyperparathyroidism. 25-OHCC therapy was more effective than vitamin D in reversing the disordered state, possibly because of impaired hepatic metabolism of vitamin D2.
mesh_terms: D002429:Cecal Diseases / Q000601:surgery*; D003125:Colostomy; D005198:Fanconi Syndrome / Q000188:drug therapy / Q000209:etiology*; D006505:Hepatitis / Q000150:complications*; D006801:Humans; D006887:Hydroxycholecalciferols / Q000627:therapeutic use*; D006962:Hyperparathyroidism, Secondary / Q000150:complications; D007081:Ileostomy; D007082:Ileum / Q000601:surgery; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases; D007410:Intestinal Diseases / Q000150:complications* / Q000601:surgery; D008286:Malabsorption Syndromes / Q000150:complications; D008297:Male; D009336:Necrosis / Q000601:surgery; D010024:Osteoporosis / Q000188:drug therapy / Q000209:etiology; D014556:Urine / Q000032:analysis; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D006887:Hydroxycholecalciferols; D014807:Vitamin D