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case_report·pediatrics, endocrinology, nutrition, micronutrients, vitamins·PMC10205217

An interesting case of unintentional vitamin D toxicity in an infant due to erroneous supplement concentration: a case report

Annals of Medicine and Surgery · 10 authors, 2 centres

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TL;DR

This case report describes a 2.5-month-old healthy term-born female infant who presented with failure to thrive, fever, nasal blockage, poor feeding, and dehydration.

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This case report describes a 2.5-month-old healthy term-born female infant who presented with failure to thrive, fever, nasal blockage, poor feeding, and dehydration. Biochemical evaluation revealed severe hypercalcemia (total serum calcium 6.0 mmol/l), markedly elevated 25-hydroxy vitamin D (>160 ng/ml), and suppressed parathyroid hormone (3.7 pg/ml). The infant had received this mega dose since the third day of birth. Treatment consisted of intravenous fluid hydration and prednisolone, with discontinuation of the supplement. Serum calcium and 25-OHD normalized over 2 months, and weight gain resumed.

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case_report

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pediatrics

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ORIGINAL PAPER

PMC10205217

An interesting case of unintentional vitamin D toxicity in an infant due to erroneous supplement concentration: a case report

Annals of Medicine and Surgery

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ABSTRACT

Introduction and importance: Despite the rare occurrence of vitamin D toxicity in infants, increased use of vitamin D formulations as well as incorrect supplement concentration by manufacturing pharmaceutical companies, has contributed to an increased incidence of vitamin D toxicity. Over-the-counter vitamin D preparation constitutes variable concentrations that can render life-threatening consequences in children. Case presentation: Here, we present a case of a 2.5-month-old infant presenting with failure to thrive. The clinical presentations were nasal blockage, noisy breathing, poor feeding, lethargy, dehydration, and fever for 3 days with decreased appetite. Her urine culture report showed a urinary tract infection. The biochemical evaluation demonstrated raised total serum calcium (6.0 mmol/l) and serum 25-hydroxy vitamin D (>160 ng/ml) with suppressed parathyroid hormone concentration (3.7 pg/ml), which was the major concern to the clinicians. On ultrasonographical examination, nephrocalcinosis was observed. Further evaluation unveiled that the vitamin D supplement administered to the infant constituted a deucedly high dose of 42 000 IU instead of the recommended dose of 0.5 ml of 800 IU. Clinical discussion: The patient developed vitamin D toxicity after consuming a mega dose of vitamin D supplements due to a manufacturer error. Conclusions: Hypervitaminosis D has severe life-threatening consequences like failure to thrive in otherwise healthy-born infants. Regular monitoring of vitamin D supplements administered in infants by medicinal practitioners and strict supervision of all stages of the production process by pharmaceutical companies is crucial to prevent complications from supplement overdose.

CITATION EXPORT

Nikita Kharal, Anuradha Kadel, Srijana Sapkota et al.. An interesting case of unintentional vitamin D toxicity in an infant due to erroneous supplement concentration: a case report. Annals of Medicine and Surgery. (2023). https://doi.org/10.1097/MS9.0000000000000528

AUTHORS

10 · 2 CENTRES

Nikita Kharal, Anuradha Kadel, Srijana Sapkota, Prakash Pokhrel, Sujata Baidya, Machhindra Lamichhane, Arun K. Sharma, Eans T. Tuladhar, Vijay K. Sharma, Apeksha Niraula

aDepartment of Clinical Biochemistry
bDepartment of Pediatrics, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal