Hypervitaminosis
Objectives- List the two vitamins most often associated with hypervitaminosis in children
- Describe the major lifethreatening effects of these hypervitaminoses
Discussion
Hypervitaminoses A and D have been described in children. Their occurrence is rare, in the US, dietary aberrations are most often responsible for cases of hypervitaminosis A, but an epidemic of hypervitaminosis D was reported following excess fortification of vitamin D in milk. Both are lifethreatening on an acute basis; vitamin A from increased intracranial pressure and vitamin D from hypercalcemia (two deaths were recorded in a patient ingesting the hyperfortified milk). If a child with hypervitaminosis A survives, evidence of increased bone turnover may be found with periosteal reaction and physeal lesions. Tenderness may be noted over the affected bones.
References
- Bendich A, Langseth L. Safety of vitamin A. American Journal of Clinical Nutrition 1989; 49( 2): 358-71.
- Blank S, Scanlon KS, Sinks TH, Lett S, Falk H. An outbreak of hypervitaminosis D associated with the overfortification of milk from a home-delivery dairy. American Journal of Public Health 1995; 85( 5): 656-9.
- Fogelman I, McKillop JH, Cowden EA, Fine A, Boyce B, Boyle IT, et al. Bone scan findings in hypervitaminosis D: case report. Journal of Nuclear Medicine 1977; 18( 12): 1205-7.
- Gamble JG, Ip SC. Hypervitaminosis A in a child from megadosing. Journal of Pediatric Orthopedics 1985; 5( 2): 219-21.
- Miller JH, Hayon, II. Bone scintigraphy in hypervitaminosis A. AJR. American Journal of Roentgenology 1985; 144( 4): 767-8.
- Ruby LK, Mital MA. Skeletal deformities following chronic hypervitaminosis A; a case report. Journal of Bone & Joint Surgery -American Volume 1974; 56( 6): 1283-7.
- Zaleske DJ. Metabolic and endocrine abnormalities. In: Morrissy RT, Weinstein SL, editors. Pediatric Orthopaedics. Philadelphia: Lippincott-Raven; 1996. p. 137-201.
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