Published online August 31, 2005
PEDIATRICS Vol. 116 No. 3 September 2005, pp. e453-e456 (doi:10.1542/peds.2004-2580)
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ELECTRONIC ARTICLE

Acute Vitamin D Intoxication in a Child

Fermin Barrueto, Jr,, MD*, Helena H. Wang-Flores, DO*,{ddagger}, Mary Ann Howland, PharmD§,||, Robert S. Hoffman, MD§ and Lewis S. Nelson, MD§

* Division of Emergency Medicine, Department of Surgery
{ddagger} Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
§ New York City Poison Control Center, New York University School of Medicine, Bellevue Hospital, New York, New York
|| School of Pharmacy, St John's University, Jamaica, New York

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 600000 IU of vitamin D; therefore, the boy received a total of 2400000 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.

Key Words: vitamin D • overdose

Abbreviations: AAP, American Academy of Pediatrics

Accepted Mar 15, 2005.




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