Doireau V, Macher M A, Brun P, Bernard O, Loirat C
Service de néphrologie, hôpital Robert-Debré, Paris, France.
Arch Pediatr. 1996 Sep;3(9):888-90. doi: 10.1016/0929-693x(96)87580-4.
Patients with chronic renal failure are at risk of vitamin A intoxication, a risk that must be evoked when unexplained hypercalcemia occurs.
An 8 year-old boy with Alagille syndrome and chronic renal failure was admitted because of general deterioration, and bone pain. Severe hypercalcemia (3.9 mmol/L) was present. Serum phosphate, parathyroid hormone and 25 OH D3 levels were normal; 1-25 (OH)2 D3 levels were undetectable. Hypercalcemia was attributed to vitamin 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 confirmed by high plasma levels of retinol (1475 micrograms/L). Hypercalcemia only partially responded to treatment with bisphosphonates, calcitonin and dialysis with low calcium dialysate. Serum vitamin A levels remained elevated one month after vitamin A withdrawal. The boy died two months after admission from atrioventricular block.
Vitamin A administration induces a high risk of intoxication in patients with chronic renal failure. Serum vitamin A concentrations are elevated in these patients, because of decreased renal metabolism of retinol, and vitamin A supplements must be avoided.
慢性肾衰竭患者存在维生素A中毒风险，当出现不明原因的高钙血症时必须考虑到这一风险。
一名8岁患有阿拉吉列综合征和慢性肾衰竭的男孩因全身状况恶化和骨痛入院。存在严重高钙血症（3.9 mmol/L）。血清磷酸盐、甲状旁腺激素和25-OH D3水平正常；1,25-(OH)2 D3水平检测不到。高钙血症归因于维生素A中毒，因为至少2年以来平均每日给予12000 IU维生素A。血浆视黄醇水平高（1475微克/升）证实了诊断。高钙血症仅对双膦酸盐、降钙素治疗以及使用低钙透析液进行透析有部分反应。停用维生素A一个月后血清维生素A水平仍升高。该男孩入院两个月后死于房室传导阻滞。
给予慢性肾衰竭患者维生素A会导致高中毒风险。由于视黄醇的肾脏代谢减少，这些患者的血清维生素A浓度升高，必须避免补充维生素A。
