Barrueto Fermin, Wang-Flores Helena H, Howland Mary Ann, Hoffman Robert S, Nelson Lewis S
Division of Emergency Medicine, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Pediatrics. 2005 Sep;116(3):e453-6. doi: 10.1542/peds.2004-2580.
We present the unique case of a previously healthy, 2-year-old boy with resistant hypercalcemia and hypertension resulting from an unintentional overdose with an imported vitamin D supplement. The patient presented initially to the emergency department with colic and constipation and was discharged after a benign physical examination. The symptoms persisted and, on the second visit, the patient was found to have a serum calcium level of 14.4 mg/dL. Despite therapy with intravenously administered 5% dextrose solution at one-half normal strength, furosemide, calcitonin, and hydrocortisone, the calcium concentration increased to 15.0 mg/dL on the second hospital day and did not decrease until the fourth hospital day, when it fell to 13.9 mg/dL. The vitamin D concentration peaked at 470 ng/mL on hospital day 3. With additional questioning, the mother revealed that she had been giving her son a daily dose of 1 ampule of Raquiferol, an imported vitamin D supplement, instead of the recommended 2 drops per day. Each ampule contained 600,000 IU of vitamin D; therefore, the boy received a total of 2,400,000 IU over 4 days. The patient's hypercalcemia persisted for 14 days and was complicated by persistent hypertension. No renal, cardiac, or neurologic complications were noted. At discharge, the vitamin D concentration was still elevated at 389 ng/mL and the total calcium level had decreased to 11 mg/dL. The boy made a complete clinical recovery. This case highlights the need for caution when using imported and/or unregulated medicines, as well as the dangers of parental dosing errors.
我们报告了一例独特的病例，一名此前健康的2岁男孩因意外过量服用进口维生素D补充剂而出现难治性高钙血症和高血压。患者最初因腹痛和便秘到急诊科就诊，经体格检查未发现异常后出院。症状持续存在，再次就诊时，发现患者血清钙水平为14.4mg/dL。尽管使用了静脉注射的半量等渗5%葡萄糖溶液、呋塞米、降钙素和氢化可的松进行治疗，但在住院第二天钙浓度仍升至15.0mg/dL，直到住院第四天才降至13.9mg/dL。维生素D浓度在住院第3天达到峰值470ng/mL。经进一步询问，母亲透露她一直给儿子每天服用1支Raquiferol（一种进口维生素D补充剂），而不是推荐的每天2滴。每支含有600,000IU维生素D；因此，男孩在4天内共摄入了2,400,000IU。患者的高钙血症持续了14天，并伴有持续性高血压。未发现肾脏、心脏或神经系统并发症。出院时，维生素D浓度仍升高至389ng/mL，总钙水平已降至11mg/dL。男孩临床完全康复。该病例强调了使用进口和/或无监管药品时需谨慎，以及家长给药错误的危险性。
