Vitamin D poisoning
Introduction
Introduction Vitamin D poisoning is one of the iatrogenic diseases. VitD poisoning is mainly due to the misdiagnosis and obsolescence of vitamin D preparations such as cod liver oil, vitamin D2 (calciferol), vitamin D2 (cholecalciferol or bividin) and vaginal calcium in the prevention and treatment of rickets. Loss of appetite, 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. Strictly follow the doctor's advice. Close monitoring of medication is an effective measure to prevent the occurrence of this condition.
Cause
Cause
There are several reasons for case poisoning:
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 a sign of pillow baldness, Hao's ditch, etc., given 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, baldness, weakness, and other symptoms in one or two of the symptoms, that is, mistaken for rickets to give assault therapy. X-ray examination also often misdiagnoses the normal variation of the distal ulna into 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.
Examine
an examination
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.
Mild: Poisoning can be characterized by low fever, irritability, anorexia, nausea, vomiting, diarrhea, constipation, thirst, and weakness.
Severe symptoms: high fever, polyuria, oliguria, dehydration, lethargy, coma, convulsions and other symptoms may occur in the advanced stage. Severe cases can be caused by hypercalcemia and renal failure.
Mainly based on the history of 1 application of excessive VitD, such as daily dose of more than 4000 IU, continuous use of several months or repeated high-dose intramuscular injection history. 2 blood calcium increased, urinary calcium positive. The 3X line photo is abnormal. However, it should be noted that the X-ray changes during early poisoning are not obvious, the blood calcium is not high during the recovery period and sequelae of poisoning, and the symptoms of poisoning and the dose of VitD are not. In medical practice, the use of large doses is not too small, but the poisoning is not too much, which is likely related to the metabolic characteristics of VitD. VitD enters the human body and needs to be transformed into 25(OH)D by the liver, and then converted to 1,25(OH)2D by the kidney. Only the latter can have strong biological activity. Normal people have a feedback adjustment mechanism so that the yield of 25(OH)D and 1,25(OH)2D is not too high. It is estimated that the symptoms of poisoning only occur when the amount of VitD is too large, the body is difficult to adjust and control, or the regulation mechanism is abnormal. In general, long-term chronic poisoning cases are easy to see X-ray abnormalities. In the early stage of acute poisoning, serum 25-OHD and blood calcium were elevated, and then the changes of osteophytes occurred. During the treatment, blood calcium is restored first, and the X-ray examination of the epiphysis is gradually restored. X-ray positive can help diagnose, while negative can not negate VitD poisoning.
The earliest symptoms were loss of appetite, 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. Older children may have headaches, blood pressure may increase or decrease, heart may smell systolic murmur, ST segment of ECG may increase, and sometimes 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. Vitamin D poisoning in the first trimester can cause fetal malformations.
Diagnosis
Differential diagnosis
Infection should be excluded with low fever. Polyuria is easily misdiagnosed as a urinary tract infection, but the effect of antibiotic treatment is not satisfactory. Hypercalcemia should be differentiated from infants with idiopathic hypercalcemia, hyperparathyroidism, malignant tumor bone metastasis, and low alkaline phosphatase. Idiopathic hypercalcemia is similar to VitD poisoning but has no history of excessive VitD. Symptoms of hyperparathyroidism are also the same as VitD poisoning, and blood calcium is also elevated, but X-ray shows generalized bone sparse and is ineffective with adrenocortical hormone therapy. In addition, from the X-ray bone film, it is still necessary to identify with the recovery period of rickets, lead, fluorosis, etc., combined with medical history, physical signs, sputum and blood calcium.
