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Hypercalcemia caused by iatrogenic hypervitaminosis A

https://doi.org/10.1016/j.jada.2004.10.006Get rights and content

Abstract

Vitamin A toxicity produces protean clinical manifestations involving a wide variety of tissues and systems. Hypercalcemia can occasionally be associated with high vitamin A levels, but is rare. In this report we describe a patient who was receiving a commercially prepared enteral feeding formula for 2 years. He developed asymptomatic hypercalcemia and had serum vitamin A levels several fold above normal. Subsequently, a custom-made enteral feed was used which contained negligible amounts of vitamin A. Several months later, vitamin A levels diminished substantially and serum calcium levels returned to normal.

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Case report

The patient described in this report was initially admitted to our hospital in June 2001 with multiple cranial nerve palsies and bilateral lower extremity weakness. On further evaluation including cerebrospinal fluid analysis, a diagnosis of Miller-Fisher variant of Guillain-Barré syndrome was made. Eight days after admission, the patient suffered respiratory arrest secondary to a bronchial mucous plug and was emergently intubated. During the arrest, he experienced considerable anoxic brain

Discussion

In 1953, Shaw and Niccoli (2) first described hypercalcemia as a complication of vitamin A therapy. Since that time, only 10 additional patients have been reported with this unique association. Hypercalcemia in the setting of vitamin A toxicity has been described in anecdotal reports, and is seen in three groups of patients. The first group of patients are those who receive all-trans retinoic acid therapy for treatment of acute promyelocytic leukemia (3). The second group is hemodialysis

K. Bhalla is a chief medical resident and instructor, D. M. Ennis is a member of the teaching faculty in medicine and transitional year residency training programs, and E. D. Ennis is the vice president of medical education and research, and program director of the internal medicine residency program, all at Baptist Health System, Birmingham, AL.

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K. Bhalla is a chief medical resident and instructor, D. M. Ennis is a member of the teaching faculty in medicine and transitional year residency training programs, and E. D. Ennis is the vice president of medical education and research, and program director of the internal medicine residency program, all at Baptist Health System, Birmingham, AL.

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