Vitamin D poisoning
Introduction
Introduction to vitamin D poisoning Vitamin D poisoning is one of the iatrogenic diseases, mainly due to the misdiagnosis and obsolescence of vitamin D in the prevention and treatment of rickets. Early symptoms are loss of appetite, and even anorexia, irritability, crying, lack of energy, and low fever. Can also have sweating, nausea, vomiting, diarrhea or constipation, gradually appearing polydipsia, frequent urination, nocturia, occasional dehydration and acidosis. Can headache, blood pressure can rise or fall, the heart can smell systolic murmur, ECG ST segment can be raised, there may be mild anemia. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: nausea and vomiting, diarrhea, constipation, anemia, renal failure
Cause
Causes of vitamin D poisoning
Physiological factors (30%):
Excessive amount of prevention, excessive intake of vitamin D daily, or high doses of vitamin D repeated intramuscular injection within a few months. Generally, children take 500-120g (20,000 IU - 50,000 IU) or 50g/kg per day or 50g/kg (200IU/kg) per day. Sensitive children can take 100g (400IU) per day for 1-3 months. Poisoned.
Pathological factors (30%):
Misdiagnosis of other bone metabolic diseases or endocrine diseases as rickets and long-term high-dose intake of vitamin D, vitamin D toxic doses vary widely, and can be poisoned for weeks or months.
Other factors (25%):
In the short term, large doses of vitamin D are given to treat rickets.
Prevention
Vitamin D poisoning prevention
Control the amount of prevention, pay attention to maintain water and electrolyte balance. Parents should take their vitamin D when taking vitamin D. Do not add it at will. If D poisoning has occurred, you should go to a nearby hospital immediately. Stop taking vitamin D, eat foods that contain less calcium, and get less sun. If necessary, take the medicine according to the doctor's sputum, increase the calcium diarrhea, reduce the absorption of calcium, and gradually improve the condition.
Complication
Vitamin D poisoning complications Complications nausea and vomiting diarrhea constipation anemia renal failure
Complications: headache, blood pressure can be increased or decreased, the heart can smell systolic murmur, the ST segment of the ECG can be elevated, and there may be mild anemia. Severe cases can present with mental depression, low muscle tone, movement disorders, and even coma and convulsions, kidney failure. The urine has a low specific gravity and is fixed, urine protein is positive, cells are increased, and tube type can also be used. Long-term chronic poisoning can cause calcification in bones, kidneys, blood vessels and skin, affecting physical and intellectual development. In severe cases, death can occur due to renal failure.
Symptom
Symptoms of vitamin D poisoning Common symptoms Diarrhea Metabolic acidosis Appetite loss Vomiting Constipation Blood pressure drop Anorexia Low fever Irritability Hyperhidrosis
Early symptoms are loss of appetite, and even anorexia, irritability, crying, lack of energy, and low fever. Can also have sweating, nausea, vomiting, diarrhea or constipation, gradually appearing polydipsia, frequent urination, nocturia, occasional dehydration and acidosis. Can headache, blood pressure can rise or fall, the heart can smell systolic murmur, ECG ST segment can be raised, there may be mild anemia. Severe cases can present with mental depression, low muscle tone, movement disorders, and even coma and convulsions, kidney failure. The urine has a low specific gravity and is fixed, urine protein is positive, cells are increased, and tube type can also be used. Long-term chronic poisoning can cause calcification in bones, kidneys, blood vessels and skin, affecting physical and intellectual development. In severe cases, death can occur due to renal failure.
Examine
Vitamin D poisoning check
Auxiliary examination: serum 25 hydroxy D increased, blood calcium increased, blood phosphorus and alkaline phosphatase were normal or slightly lower, and plasma cholesterol was normal or elevated. Early blood calcium elevation > 3mmol / L (12mg / dl) strong urinary calcium positive (Sulkowitch reaction).
Urine routine examination showed positive urine protein, and red blood cells and white blood cell casts were seen in severe cases.
X-ray examination showed that the long bone calcification zone was widened (>1mm), the backbone cortex was thickened, osteoporosis or osteosclerosis, the skull was thickened, and the ring density deepening zone was present. In severe cases, the brain, heart, kidney and large There are calcifications in blood vessels and skin, which may cause azotemia, dehydration and electrolyte imbalance.
Kidney B ultrasound showed renal atrophy.
Diagnosis
Diagnosis and identification of vitamin D poisoning
Diagnosis: There is a history of vitamin D overdose, because the early symptoms are not specific, and overlap with the symptoms of early rickets, such as irritability, excessive sweat, etc., should be carefully asked to identify the history. Early blood calcium elevation > 3mmol / L (12mg / dl) strong urinary calcium positive (Sulkowitch reaction).
The reliable X-ray sign of vitamin D poisoning is: the southern bone of the ulna and ulna is obscured and has periosteal reaction; cortical bone loosening or osteoporosis; the metaphyseal humeral end-stalk or "sparse" sputum; thickening of the backbone cortex Dense, carpalized bone calcification ring thickening and hardening.
