vitamin D toxicity
Introduction
Introduction to vitamin D poisoning Vitamin Dintoxication is one of the iatrogenic diseases. VitD poisoning is mainly caused by misdiagnosis and obsolescence of vitamin D preparations such as cod liver oil, vitamin D2 (calciferol), vitamin D2 (cholecalciferol or Gentamicin and Weiding gelatinous calcium. When the body takes a lot of vitamin D, the body's vitamin D feedback is deregulated, the intestinal absorption of calcium and phosphorus increases, the blood calcium concentration is too high, and calcitonin regulates the deposition of blood calcium in bone and other organ tissues, affecting its function. basic knowledge The proportion of sickness: 0.01% Susceptible people: seen in children Mode of infection: non-infectious Complications: renal failure vitamin D poisoning
Cause
Causes of vitamin D poisoning
Cause:
1 did not know in detail the dose of vitamin D used in children in the past, simply sue eat more or eat often cod liver oil, and ignore the correct dosage and course of treatment for parents D, and parents believe that vitamins are nutrients, eat As many as possible, give your child long-term use.
2 did not comprehensively analyze the diagnosis and severity of rickets in children, even because of a symptom of hyperhidrosis or alopecia areata, Hao's ditch and other signs, give a large dose of assault treatment.
3 pieces meet the requirements of parents, think that "injection and save trouble" or "injection management", fluently D2 or D3 several times.
4 diagnosis errors, such as late teething, walking late, irritability, sweating, post-occipital baldness, weakness and other symptoms in one or two, that is, mistaken for rickets to give assault therapy, X-ray examination also often normal ulnar distal The mutation was misdiagnosed as a rickets.
5 children who are sensitive to vitamin D take vitamin D 4000IU every day, and symptoms of poisoning can occur after 1 to 3 months.
Prevention
Vitamin D poisoning prevention
1 Strictly control the amount of preventive or therapeutic treatment of VitD. The daily dose of preventive dose should not exceed 400 IU. The risk of VitD overdose should be publicized to parents. It is necessary to use the medicine according to the doctor's advice and strengthen the vitamin AD milk. The amount of VD can be supplemented to avoid poisoning.
2 Before the need for surprise treatment, the dose of VitD used in the past should be inquired in detail. According to the most cases of poisoning, the long-term large-scale oral administration of cod liver oil is more likely to cause symptoms of poisoning after D2 or D3 injection, so before injection of large doses Be sure to master the indications.
3 When the general VitD dose is not satisfactory, blood calcium, phosphorus and alkaline phosphatase should be checked before deciding whether to use assault therapy.
4 prevention and treatment of general nutritional rickets to avoid large doses of VD assault, in the application of high-dose VitD treatment, close observation of clinical symptoms, monthly blood calcium indications, if necessary, every half month, should pay attention to VitD is An accumulated drug that is stored in body fat and muscle for a long time. The measured calcium level represents the sum of several months of treatment.
5 Practice has proved that VD20IU has the same effect as 400,000 IU. It is best not to exceed 20 IU when high-dose VitD assault treatment is used. Generally, the second injection is not needed. The oral VD of the liver, kidney and gastrointestinal function is the same as that of the intramuscular injection. Oral safe, no intramuscular injection if necessary.
Complication
Vitamin D poisoning complications Complications, renal failure, vitamin D poisoning
Long-term chronic poisoning can cause bones, kidneys, blood vessels, skin calcification, affecting physical and intellectual development, severe cases can cause death due to renal failure, vitamin D poisoning can cause fetal malformation in early pregnancy.
Symptom
Vitamin D poisoning symptoms Common symptoms Vitamin D poisoning Loss of appetite urinary frequency sleepiness oliguria constipation systolic murmur phlegm hypercalcemia dehydration
VitD poisoning is common in general symptoms and lacks specificity. Therefore, mild symptoms are often difficult to be noticed, and even more symptoms are considered to be given to VitD in early symptoms of rickets. After symptoms are obvious, they are easily misdiagnosed as other diseases.
The earliest symptoms are loss of appetite, even anorexia, irritability, crying, lack of energy, low fever, sweating, nausea, vomiting, diarrhea or constipation, gradual polydipsia, frequent urination, nocturia, occasional Dehydration and acidosis, older children can talk about headache, blood pressure can rise or fall, the heart can smell systolic murmur, ECG ST segment can be elevated, sometimes mild anemia, severe cases can appear mental depression, Low muscle tone, movement disorders, even coma, renal failure, etc., low urine specific gravity, positive urine protein, increased cells, can also have cast, long-term chronic poisoning can cause bones, kidneys, blood vessels, skin corresponding Calcification affects physical and intellectual development. In severe cases, it can cause death due to renal failure. Vitamin D poisoning can cause fetal malformation in early pregnancy.
Examine
Vitamin D poisoning check
Laboratory inspection
It can be seen that serum 25 hydroxy D is increased, blood calcium is increased (>3.0mmol/L (12mg/dl)), blood phosphorus and alkaline phosphatase are normal or slightly lower, plasma cholesterol is normal or elevated, and in a few cases, urea nitrogen is elevated. Abnormal renal function, such as low specific gravity and fixed urine, positive urine protein, tube type and other cells.
X-ray examination
The metaphyseal hardening zone is one of the common X-ray signs of vitamin D poisoning, but it is not a characteristic manifestation. The reliable X-ray sign of vitamin D poisoning is: 1 foot sacral dry skin, southern bone is blurred and has periosteal reaction, 2 cortical bone pine Or osteoporosis, 3 feet of humeral metaphysis, or "small" sputum, 4 thick and dense bone cortex, 5 carpal ossified calcification ring thickening and hardening, the above five X-ray signs appear simultaneously Three kinds of signs can be diagnosed as vitamin D poisoning. Of course, it must be combined with clinical history and overdose of VitD to confirm the diagnosis. In severe cases, renal, blood vessels, heart and limb soft tissues have metastatic calcification.
Diagnosis
Diagnosis and identification of vitamin D poisoning
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
In addition to low fever, infection must be excluded, polyuria is easily misdiagnosed as urinary tract infection, but the effect of antibiotic treatment is not satisfactory, hypercalcemia should occur with infants with idiopathic hypercalcemia, hyperparathyroidism, malignant tumor bone Metastasis, identification of hypoalkaline phosphatase, idiopathic hypercalcemia is similar to VitD poisoning, but no history of excessive VitD, hyperparathyroidism is the same as VitD poisoning, blood calcium is also elevated, but X-ray showed general osteoporosis, treatment with adrenocortical hormone was not effective, in addition, seen from X-ray bone tablets, it is still necessary to identify with the recovery period of rickets, lead, fluorosis, etc., combined with medical history, signs, sputum and Blood calcium and other aspects are considered.
