Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
University Medical Center, Lubbock, TX, USA.
J Burn Care Res. 2022 Nov 2;43(6):1445-1448. doi: 10.1093/jbcr/irac101.
Vitamin and steroid supplementation such as oxandrolone are commonly given to speed the recovery process in severe burn injuries. Vitamin A is administered concurrently with steroids because of its pro-inflammatory and positive effects on wound healing. However, vitamin A supplementation warrants caution as hypercalcemia can result from vitamin A overdose. Our case involves an 18-year-old male injured in an oil field explosion who presented with 55% total body surface area (TBSA) partial- and full-thickness burns. Following successful resuscitation, he was given vitamin A, oxandrolone, vitamin C, and zinc sulfate as part of the standard vitamin supplementation. On hospital day (HD) 33, serum calcium levels were noted to be elevated and increased to 13 mg/dL a few days later. Parathyroid hormone and vitamin D levels were found to be within normal range, and urine analysis showed normal calcium excretion. Subsequent assessment of vitamin A levels revealed significantly elevated levels at 93 mcg/dL. Vitamin A supplementation was discontinued, and the patient was discharged on HD 42. At the 1-month follow-up, serum calcium levels were normal, which links the hypercalcemia to vitamin A overdose. This case highlights the importance of considering vitamin A overdose as a cause for asymptomatic hypercalcemia with a normal parathyroid and vitamin D workup. While routine, vitamin A supplementation in burn patients calls for assessment of both serum calcium and vitamin A levels throughout the hospital stay to prevent hypercalcemia and its negative effects.
维生素和类固醇补充剂，如氧雄龙，常用于加速严重烧伤的康复过程。由于维生素 A 具有抗炎和促进伤口愈合的积极作用，因此与类固醇同时给予维生素 A。然而，维生素 A 补充剂需要谨慎，因为过量摄入维生素 A 会导致高钙血症。我们的病例涉及一名 18 岁男性，他在油田爆炸中受伤，全身 55%面积为部分和全层烧伤。在成功复苏后，他接受了维生素 A、氧雄龙、维生素 C 和硫酸锌作为标准维生素补充的一部分。在入院第 33 天，发现血清钙水平升高，并在几天后升高至 13mg/dL。甲状旁腺激素和维生素 D 水平在正常范围内，尿液分析显示钙排泄正常。随后评估维生素 A 水平显示其水平显著升高至 93 mcg/dL。停止了维生素 A 补充，患者在入院第 42 天出院。在 1 个月的随访中，血清钙水平正常，这将高钙血症与维生素 A 过量联系起来。该病例强调了在甲状旁腺和维生素 D 检查正常的情况下，将无症状性高钙血症视为维生素 A 过量的原因的重要性。虽然常规给予烧伤患者维生素 A 补充剂，但在整个住院期间需要评估血清钙和维生素 A 水平，以预防高钙血症及其负面影响。
