[Vitamin A poisoning revealed by hypercalcemia in a child with kidney failure].
BACKGROUND
Patients with chronic renal failure are at risk of vitamin A intoxication, a risk that must be evoked when unexplained hypercalcemia occurs.


METHODS
An 8 year-old boy with Alagille syndrome and chronic renal failure was admitted because of general deterioration, and bone pain. Severe hypercalcemia (3.9 mmol/L) was present. Serum phosphate, parathyroid hormone and 25 OH D3 levels were normal; 1-25 (OH)2 D3 levels were undetectable. Hypercalcemia was attributed to vitamin A intoxication, due to the administration of a mean daily dose of 12000 IU of vitamin A for at least 2 years. The diagnosis was confirmed by high plasma levels of retinol (1475 micrograms/L). Hypercalcemia only partially responded to treatment with bisphosphonates, calcitonin and dialysis with low calcium dialysate. Serum vitamin A levels remained elevated one month after vitamin A withdrawal. The boy died two months after admission from atrioventricular block.


CONCLUSIONS
Vitamin A administration induces a high risk of intoxication in patients with chronic renal failure. Serum vitamin A concentrations are elevated in these patients, because of decreased renal metabolism of retinol, and vitamin A supplements must be avoided.
Doireau
V
V
Service de néphrologie, hôpital Robert-Debré, Paris, France.
Macher
M A
MA
Brun
P
P
Bernard
O
O
Loirat
C
C
D016738:Alagille Syndrome / Q000150:complications; D002648:Child; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006986:Hypervitaminosis A / Q000097:blood*; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male
Intoxication à la vitamine A révélée par une hypercalcémie chez un enfant insuffisant rénal.