Pleural effusion and ascites: unusual presenting features in a pediatric patient with vitamin A intoxication.
The usual presenting features of vitamin A intoxication are pseuotumor cerebri, skeletal pain, desquamative dermatitis, and hepatic inflammation. Our patient was a nine-year-old female who had increasing cough, dyspnea, and abdominal distention for a short time prior to admission. She was said to have been treated with 10,000 units of vitamin A per day for skin rashes. Radiographic studies revealed a very large right sided pleural effusion, ascites, demineralized bones, and retarded skeletal maturation. The diagnosis of hypervitaminosis A was made. More detailed medical history confirmed that the child had, in actuality, received up to 300,000 units/day of vitamin A plus desiccated liver pills and carrot juice for the previous year. Clinical symptoms completely abated following acute medical treatment for ascites and cessation of vitamin A intake. Several months later, a sample of liver, obtained and preserved at the time of exploratory laparotomy, was homogenized and extracted with ethanol/hexane. The retinyl palmitate level was significantly elevated and consistent with vitamin A poisoning.
D000365:Age Determination by Skeleton; D001201:Ascites / Q000150:complications* / Q000000981:diagnostic imaging; D001706:Biopsy; D002648:Child; D004224:Diterpenes; D005260:Female; D006801:Humans; D006986:Hypervitaminosis A; D008099:Liver / Q000032:analysis / Q000473:pathology / Q000648:ultrastructure; D008854:Microscopy, Electron; D010996:Pleural Effusion / Q000150:complications* / Q000000981:diagnostic imaging; D013902:Radiography, Thoracic; D000084562:Retinyl Esters; D012871:Skin Diseases / Q000188:drug therapy; D014801:Vitamin A / Q000031:analogs & derivatives / Q000032:analysis
D004224:Diterpenes; D000084562:Retinyl Esters; D014801:Vitamin A; C014794:retinol palmitate