Vitamin A intoxication

Q: 53 year old male with End-Stage renal Disease (ESRD) starts taking over the counter (OTC) multi-vitamin supplements. Patient presented with severe headache and is admitted to ICU after neurology service diagnosed him with pseudotumor cerebri. Patient was also found to have  Vitamin A intoxication. Patient is also likely to have? (select one)

A) Hypocalcemia
B) Hypercalcemia


Answer: B

Patients with ESRD should be prescribed or be cautioned against using OTC supplements. Vitamin A intoxication is a potential concern in these patients. Hypervitaminosis A may cause nausea, headache, fatigue, irritability, anorexia, hepatomegaly, and pseudotumor cerebri. It also causes hypercalcaemia due to the effect of vitamin A on bone, most likely an osteolytic effect.

#toxicology
#nephrology
#neurology


References:

1. Hammoud D, El Haddad B, Abdallah J. Hypercalcaemia secondary to hypervitaminosis a in a patient with chronic renal failure. West Indian Med J. 2014;63(1):105–108. doi:10.7727/wimj.2011.171 

2.  Lippe B, Hensen L, Mendoza G, Finerman M, Welch M. Chronic vitamin A intoxication. A multisystem disease that could reach epidemic proportions. Am J Dis Child. 1981;135:634–636.

3. Farrington K, Miller P, Varghese Z, Baillod RA, Moorhead JF. Vitamin A toxicity and hypercalcaemia in chronic renal failure. Br Med J (Clin Res Ed) 1981;282:1999–2002.