[ABSTRACT FROM AUTHOR]; Turkish: D vitamini intoksikasyonu genellikle iyatrojenik olup uygunsuz dozda D vitamini alınmasına bağlıdır. Bu olgu sunumunda. Vitamin D 25(OH)D vitamini. D vitamini osteomalazi; Language of Keywords: ng/mL’den yüksek ise D vitamini intoksikasyonu olarak kabul edilmektedir. three cases of iatrogenic vitamin D intoxication with different radiological findings SÜT ÇOCUKLARINDA İYATROJENİK D VİTAMİNİ İNTOKSİKASYONU:ÜÇ.

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EBSCOhost | | D hipervitaminozu: Olgu sunumu.

Log In Sign Up. The Turkish Journal of Pediatrics ; Turk J Pediatr ; Vitamin D intoxication VDI may result from supplementation rarely, but it has been reported more frequently in recent years. This may be attributable to an increase in vitamin D supplement intake due to an understanding of the role of vitamin D 25OHD in the pathogenesis of several diseases. The symptoms and findings associated with VDI are closely related to serum calcium concentration and duration of hypercalcemia.

The main goal of treatment for VDI is correction of the hypercalcemia. However, since vitamin D is stored in fat tissues, effects of toxicity may last for months despite the removal of the exogenous source of vitamin D. Treatment for VDI includes: All patients who are clinically suspected of VDDR should be checked for serum vitamin D status and questioned for previous vitamin D administration before starting vitamin D therapy.

On the other hand, parents of all infants should be asked whether they are using dietary or oral supplements, and serial questioning may be required during supplementation to avoid excessive intake. Vitamin D intoxication VDI usually develops Vitamin D intoxication VDI differs from due to high doses of vitamin D given by health hypervitaminosis D; the normal serum vitamin care providers, before a clear diagnosis of D levels and clinical definitions are shown in vitamin D insufficiency or rickets is established.

VDI resulting intooksikasyonu increase in the hydroxyvitamin D 25OHD supplementation has been reported rarely but levels is associated with either hypercalcemia or may now occur more vltamini. This may hypercalciuria, or both. VDI occurs in patients be attributable to an increase in vitamin D with one or more of the clinical findings listed supplement intake due to the findings that in Table II, together with the laboratory findings deficiency is common and has been associated of hypervitaminosis D.

Hypervitaminosis D with a number of disease states There is no Clinical Findings: In studies conducted nephrocalcinosis. Sequential biochemical measurements 3.

Active vitamin D ectopic calcification. Diagnosis The symptoms and findings associated with History: Most cases complaints were: However, the effects With a careful review the gastrointestinal, renal, central nervous, of the patient history, unnecessary evaluations cardiovascular, and musculoskeletal systems, can be avoided. Complications that may develop the eyes, and the skin, depending on the due to hypercalcemia may be prevented with level of hypercalcemia.

Initial and follow-up laboratory the soft tissues of intoksiiasyonu body; impairment in findings of 27 patients diagnosed with VDI, renal function, vascular calcification and renal in a study performed at our clinic, are shown hypertension may develop15, Since vitamin D is identified with nephrocalcinosis over a one- lipophilic and stored in fat tissues, the effects year intoksikaxyonu period.


On the in the loop of Henle, as well as calcification other hand, especially in infants with Down at the corticomedullary junction. Medullary syndrome or hypothyroidism, hypercalcemia nephrocalcinosis can be detected on ultrasound may easily develop due to either increased better than in X-ray or computed tomography intestinal absorption or decreased vitamin CT images. The urine calcium-creatinine D metabolism17, Therefore, in these cases, ratio should be followed in patients with vitamin D and calcium supplementation should hyper vitaminosis D to vitamink for the be carefully provided.

In patients with VDI, hypercalcemia, normal or high serum Treatment phosphorus levels, normal or low levels of The main goal of treatment in VDI is correction alkaline phosphatase ALP vitamiini, high levels of of the hypercalcemia. Sustaining or preferably bisphosphonates treatment.

Glucocorticoids prevention of the development of hypercalciuria suppress the activity of calcitriol, and reduce and nephrocalcinosis5, In addition, reabsorption discontinuing intake, a diet with low calcium through the renal tubules vitamkni prevented, and phosphorus content, intravenous IV facilitating the renal excretion of calcium.

More recently, oral and start of treatment. IV administered orally in four doses Patients with moderate and intoksjkasyonu reduces bone resorption by increasing urinary hypercalcemia must be followed closely after calcium excretion.

Calcitonin, at a dose of being hospitalized. It is effective over a period of hours hydration used for treatment increases the and has a low risk of side effects. Intermittent glomerular filtration, which leads to calcium administration is recommended due to the being filtered out of the system through the development of resistance tachyphylaxis after glomeruli. The sodium in the fluid prevents its intomsikasyonu rapid effects Bisphosphonates lead to hydration treatment. Vitamihi addition to their effects a well-planned and well-administered fluid on the lifespan of osteoclasts, they also inhibit protocol.

Caution should be exercised in osteoclast-induced bone resorption. The half- patients with cardiac and renal disease with life of bisphosphonates is less than several regard to excessive fluid loading.

d vitamini intoksikasyonu

Loop diuretics hours and they are rapidly excreted from such as furosemide and ethacrynic acid, added the circulation. Therefore, medications such to the treatment after hydration, inhibit the as PamidronateR are administered at a dose reabsorption of urinary calcium, and reduce of 0. This the calcium level by increasing urinary calcium dose may be repeated at intervals depending excretion.

To this end, furosemide can be on the serum calcium level. Therapeutic Approaches for Hypercalcemia due to Vitamin D Intoxication Intervention Mode of action Onset of Duration of action action Isotonic saline Restoration of intravascular volume Hours During hydration Increases urinary calcium excretion therapy Loop diuretics Increase urinary calcium excretion via inhibition of Hours During calcium reabsorption in the loop of Henle therapy Calcitonin Inhibits bone resorption via interference with hours 48 hours osteoclast maturation; Promotes urinary calcium excretion Bisphosphonates Inhibits bone resorption via interference with hours weeks osteoclast recruitment and function Glucocorticoids Decreases 1,dihydroxyvitamin D production days Days to by activated mononuclear cells in patients with weeks granulomatous diseases or lymphoma Dialysis Low or no calcium dialysate Hours During treatment bisphosphonate, alendronate, is safe and serum calcium levels Table IV.


Since recurrent effective for achieving rapid decreases in hypercalcemia may develop, hemodialysis hypercalcemia and hypercalciuria in infants is the preferred treatment in patients with with VDI Vitamin D is stored in fat tissue. Experience with the administration of oral and Hypercalcemia may continue for more than IV bisphosphonates in children with severe six months following VDI.

Thus, patients with hypercalcemia has increased over the past VDI should be followed until the 25OHD and several years. In a recent study, Sezer et al. Average time to achieve normocalcemia deficiency rickets VDDR without checking with prednisolone treatment was All patients who are patients achieved normocalcemia 3.

It was concluded that alendronate for previous vitamin D administration before treatment achieves normocalcemia four times starting vitamin D therapy. On the other earlier than prednisolone treatment and hand, parents of all infants should be queried shortens the hospital stay in infants with as to whether they are using dietary or oral VDI. Bisphosphonates may cause flu-like supplements, and serial questioning may be illness including fever as an acute adverse required during supplementation to avoid effect.

Long-term adverse effects are not well excessive intake. Response to bisphosphonate treatment is 1. Vitamin rapid and the duration of treatment is short D intoxication with severe hypercalcemia due to in most cases, which decreases the possibility manufacturing and labeling errors of two dietary of long-term side effects J Clin Endocrinol Metab ; Hemodialysis can be used in patients with 2.

Calcinosis and metastatic severe hypercalcemia who do not respond to calcification due to vitamin D intoxication. Horm medical treatment; it can rapidly reduce the Res ; The clinical and laboratory Renal ultrasound in metabolic bone disease.

Pediatr characteristics of vitamin D intoxication in children.

Turk J Med Sci ; Intoksikaeyonu due to vitamin D Kappy M. Drug and Therapeutics Committee of the intoxication. Lawson Wilkins Pediatric Endocrine Society.

Medical D deficiency in children and its management: Calcif Tissue Int ; of current knowledge and recommendations. Bereket A, Erdogan T. Oral bisphosphonate therapy 5. E RE, for vitamin D intoxication of the infant. Nelson Textbook of ; Intragastric alendronate therapy in two infants with 6. Disorders of calcium metabolism.

Curr vitamin D intoxication: Clin Toxicol Paediatr ; Pamidronate associated with drinking milk. N Engl J Med ; treatment in acute vitamin D intoxication. The truth about vitamin D toxicity. Hatun S, Cizmecioglu F. Use of alendronate in the http: Toxicology of selected pesticides, J Pediatr ; J Clin Res Pediatr and bromethalin-based rodenticides. Vet Clin North Endocrinol ; 2: Vitamin D deficiency 9.

Pharmacokinetics of vitamin D toxicity. Acta Paediatr ; J Clin Nutr ; The report J Trop from the Institute of Medicine: Oral alendronate therapy