title: Acute vitamin D intoxication in a child.
abstract: We present the unique case of a previously healthy, 2-year-old boy with resistant hypercalcemia and hypertension resulting from an unintentional overdose with an imported vitamin D supplement. The patient presented initially to the emergency department with colic and constipation and was discharged after a benign physical examination. The symptoms persisted and, on the second visit, the patient was found to have a serum calcium level of 14.4 mg/dL. Despite therapy with intravenously administered 5% dextrose solution at one-half normal strength, furosemide, calcitonin, and hydrocortisone, the calcium concentration increased to 15.0 mg/dL on the second hospital day and did not decrease until the fourth hospital day, when it fell to 13.9 mg/dL. The vitamin D concentration peaked at 470 ng/mL on hospital day 3. With additional questioning, the mother revealed that she had been giving her son a daily dose of 1 ampule of Raquiferol, an imported vitamin D supplement, instead of the recommended 2 drops per day. Each ampule contained 600,000 IU of vitamin D; therefore, the boy received a total of 2,400,000 IU over 4 days. The patient's hypercalcemia persisted for 14 days and was complicated by persistent hypertension. No renal, cardiac, or neurologic complications were noted. At discharge, the vitamin D concentration was still elevated at 389 ng/mL and the total calcium level had decreased to 11 mg/dL. The boy made a complete clinical recovery. This case highlights the need for caution when using imported and/or unregulated medicines, as well as the dangers of parental dosing errors.
authors.affiliation: Division of Emergency Medicine, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA. fbarr001@umaryland.edu
authors.forename: Fermin
authors.initials: F
authors.lastname: Barrueto
authors.forename: Helena H
authors.initials: HH
authors.lastname: Wang-Flores
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Howland
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hoffman
authors.forename: Lewis S
authors.initials: LS
authors.lastname: Nelson
mesh_terms: D000208:Acute Disease; D002675:Child, Preschool; D019587:Dietary Supplements / Q000506:poisoning*; D062787:Drug Overdose; D006801:Humans; D006934:Hypercalcemia / Q000139:chemically induced / Q000628:therapy; D008297:Male; D014807:Vitamin D / Q000506:poisoning*
chemical_list: D014807:Vitamin D