HYPERCALCEMIA AS THE FIRST MANIFESTATION OF CHRONIC VITAMIN-A INTOXICATION IN A CHILD WITH RENAL-FAILURE

Background.- Patients with chronic renal failure are at risk of vitami n A intoxication, a risk that must be evoked when unexplained hypercal cemia occurs. Case report.- An 8 year-old boy with Alagille syndrome a nd chronic renal failure was admitted because of general deterioration and bone pain. Severe hypercalcemia (3.9 mmol/L) was present. Serum p hosphate, parathyroid hormone and 25 OH D-3 levels were normal; 1-25 ( OH)(2) D-3 levels were undetectable. Hypercalcemia was attributed to v itamin A intoxication, due to the administration of a mean daily dose of 12000 IU of vitamin A for at least 2 years. The diagnosis was confi rmed by high plasma levels of retinol (1475 mu g/L). Hypercalcemia onl y partially responded to treatment with bisphosphonates, calcitonin an d dialysis with low calcium dialysate. Serum vitamin A levels remained elevated one month after vitamin A withdrawal. The boy died two month s after admission from atrioventricular block. Conclusion.- Vitamin A administration induces a high risk of intoxication in patients with ch ronic renal failure. Serum vitamin A concentrations are elevated in th ese patients, because of decreased renal metabolism of retinol, and vi tamin A supplements must be avoided.