Hippokratia 2004, 8(4):176-178
DB Kuzmanovska, EM Shahpazova, SJ Grujovska, MJ Kocova, E Sukareva
Nephrology Dpt, Gastroenterology Dpt, Endocrinology Dpt, University Pediatric Clinic, Skopje, F.Y.R.O.M.
We report an eight month – old female infant who presented with hypercalcemia, failure to thrive, polyuria and dehydration following excess vitamin D supplementation: the first eight months of life. At birth, she weighed 3000 gr and at admission to the hospital her weight was 6700 gr. She presented serum calcium concentration 3.6 mmol/1, calciuria 14 mg/kg and the renal ultrasound revealed nephrocalcinosis.
The intact PTH was low (< 3 pg/ml). Although 25(OH) vitamin D3 plasma level was not measured, after rehydration and after evaluation of the prevailing pathogenic mechanism, prednisone was given for treatment of hypercalcemia. The beneficial response, with no recurrence of hypercalcemia / hypercalciuria after discontinuation of prednisone and introduction regular milk formula, provides strong evidence that hypercalcemia, hypercalciuria and nephrocalcinosis were due to vitamin D intoxication.
To diagnose vitamin D intoxication, one must consider it in the differential diagnosis and obtain a history of vitamin D intake in infants with hypercalcemia / hypercalciuria and failure to thrive of obscure origin.