title: Acute kidney injury due to excessive and prolonged intramuscular injection of veterinary supplements containing vitamins A, D and E: A series of 16 cases.
abstract: BACKGROUND
  Despite well-documented risks, injectable supplements containing high doses of vitamins are commonly used.
  
  
  OBJECTIVE
  To describe acute kidney injury (AKI) as a complication of vitamin intoxication.
  
  
  METHODS
  Our series consisted of 16 patients with kidney complications resulting from the use of veterinary intramuscular injection supplements of vitamin A, D and E. The patients were admitted to two referral hospitals in Fortaleza (Brazil) between January 2010 and January 2015.
  
  
  RESULTS
  Patients' mean age was 28.3±8.9 years (19-53 years), and 11 (68.7%) were male. Main signs and symptoms upon admission were nausea (68.7%), vomiting (62.5%), weight loss (43.7%), epigastric pain (31.2%) and headache (31.2%). At hospital admission the mean laboratory values were: hemoglobin 10±2.0g/dL (6.1-14.2), leukocytes 10,542±4871/mm3(4100-15,100), creatinine 3.9±5.2mg/dL (0.7-22) and urea 91±88mg/dL (22-306), respectively. Serum calcium was 12±2.2mg/dL (8.8-15.5), 24-h urine calcium was 575±329mg (10.7-1058), serum PTH was 55±141pg/mL (2-406), and serum vitamin D concentration was 135±75ng/mL (22-265). Using KDIGO criteria, AKI was diagnosed in 13 patients (81.2%), classified as stage 1 (n=3), stage 2 (n=3) or stage 3 (n=7). No deaths occurred in the study period.
  
  
  CONCLUSIONS
  Excessive use of veterinary vitamin supplements containing high doses of vitamin A, D and E was associated with AKI. Hypercalcaemia, which was a common finding, appears to be a contributing factor to the development of this type of AKI.
authors: Department of Internal Medicine, School of Medicine, Medical Sciences Graduate Program, Federal University of Ceará, Fortaleza, Ceará, Brazil. Electronic address: ef.daher@uol.com.br.
authors: Elizabeth
authors: E
authors: De Francesco Daher
authors: Department of Internal Medicine, School of Medicine, Medical Sciences Graduate Program, Federal University of Ceará, Fortaleza, Ceará, Brazil.
authors: Lorena Vasconcelos
authors: LV
authors: Mesquita Martiniano
authors: Department of Internal Medicine, School of Medicine, Medical Sciences Graduate Program, Federal University of Ceará, Fortaleza, Ceará, Brazil.
authors: Laio Ladislau
authors: LL
authors: Lopes Lima
authors: Department of Internal Medicine, School of Medicine, Medical Sciences Graduate Program, Federal University of Ceará, Fortaleza, Ceará, Brazil.
authors: Newton Carlos
authors: NC
authors: Viana Leite Filho
authors: Department of Internal Medicine, School of Medicine, Medical Sciences Graduate Program, Federal University of Ceará, Fortaleza, Ceará, Brazil.
authors: Louize Emanuele
authors: LE
authors: de Oliveira Souza
authors: Department of Internal Medicine, School of Medicine, Medical Sciences Graduate Program, Federal University of Ceará, Fortaleza, Ceará, Brazil.
authors: Paulo Henrique Palácio
authors: PH
authors: Duarte Fernandes
authors: School of Medicine, Public Health Graduate Program, University of Fortaleza, Fortaleza, Ceará, Brazil.
authors: Sonia Leite
authors: SL
authors: da Silva
authors: School of Medicine, Public Health Graduate Program, University of Fortaleza, Fortaleza, Ceará, Brazil.
authors: Geraldo Bezerra
authors: GB
authors: da Silva Junior
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced* / Q000628:therapy; D000328:Adult; D000073880:Body Contouring; D019587:Dietary Supplements / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000139:chemically induced; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D019155:Veterinary Drugs / Q000009:adverse effects*; D014801:Vitamin A / Q000009:adverse effects*; D014807:Vitamin D / Q000009:adverse effects*; D014810:Vitamin E / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D019155:Veterinary Drugs; D014801:Vitamin A; D014807:Vitamin D; D014810:Vitamin E
keywords: Acute kidney injury; Daño renal agudo; Hipercalcemia; Hypercalcaemia; Suplementos vitamínicos; Vitamin supplements