Clinic of hypervitaminosis D

The clinic study of hypervitaminosis D is of practical interest as correct diagnosis, the detection of the initial manifestations of the disease are of great importance to timely and efficient treatment.
In the period of fascination "shock doses of vitamin D (since 1935 and later) in the treatment of rickets, systemic lupus and some skin diseases, it was found that the drug can cause the phenomenon of severe intoxication, accompanied by hypercalcemia and significant, and sometimes irreversible changes in the organs (Malina, 1941; Howard, 1948; Yakubchik, singer, 1960; Gvul and others, 1961).
Already in his first works was described the clinical picture of acute D-vitamin toxicity, manifested by a sharp deterioration of appetite, nausea, constipation and abdominal pain. In adults, there was often General and muscular weakness, drowsiness, headache, polydipsia in the presence of dehydration. At the same time revealed violations of the different organs and systems, especially the kidneys, heart and nervous system (Ross, Willaiams, 1939; Scheider, Kammer, 1948; Pleskova and others, 1962; Rubin, 1964; Gabriel, 1970). Follow-up observations have allowed to study long-term effects of the application of substantial doses of vitamin D, especially on the part of the kidney, in the form of proteinuria and increased amounts of calcium in the urine. Rentgenograficheskie in the lungs, large blood vessels, lymph nodes and soft tissues often identified foci of calcification (Ptaffenschlager, 1964; Vishnevsky, 1967; Siskova and others, 1971).
Studies have shown that an overdose of vitamin D leads to the development of hypercalcemia, providing a variety of pathological influence on the entire body. It was found that gipervitaminoz D is a common disease of the whole body, often with a significant defeat of a number of organs and systems.
Clinic of hypervitaminosis D in children diverse. Great influence on the clinical manifestation has a number of factors, including the nature of breastfeeding, the method and duration of intake of vitamin D, as well as the age of the child. According to literary data, faster development of intoxication and the growth of the leading symptoms occur in the first three months of a child's life. This is due to the age peculiarities of metabolic processes, and lability of enzyme systems (Shishkov, 1971). Various comorbidities (malnutrition, exudative diathesis, traumatic brain injuries and other) affect the course of the basic disease.
The clinic study of hypervitaminosis D has allowed to establish that the disease occurs in the form of acute and chronic intoxication (Pleskava, 1967). Acute intoxication usually occurs while receiving high or high doses of vitamin D within 2-12 weeks and chronic, with the admission of the drug over a long time: from 5 to 8 months and more. The main clinical manifestations acute and chronic toxicity presented in table 3.
. As seen from table 3, in acute intoxication a child has a serious condition in connection with the development of toxemia of II-III degree, frequent vomiting, dehydration and significant hypercalcemia. However, chronic intoxication, despite the lower the severity of clinical manifestations of the disease, leads to a significant violation of the kidney with severe proteinuria, hypophosphatemia (Pleskava, 1967).
Pathological changes in the hypervitaminosis D, especially hypercalcemia, contribute to the accumulation of salts of calcium in the myocardium, the walls of blood vessels, lungs, intestine, kidney, cornea of the eyes, kidneys and other organs. This leads to violation of the functions of vital organs. Clinical and prognostic against the greatest danger is the defeat of the heart and blood vessels, kidneys due to the development of long hypertension, renal failure.
On various aspects of the clinic of hypervitaminosis D in children published a lot of works. However, most of them are based on few observations.
Diagnosis of hypervitaminosis D was established on the basis of anamnestic data pointing to an overdose of vitamin D, as well as clinical manifestations of the disease. Clinical examination was carried out with the utmost care. This took into account the patient's medical history, especially antenatal and postnatal, specific and nonspecific prevention of rickets, the birth weight of the child, the nature of his feeding.
When gathering information about a sick child used the survey of parents and medical personnel of childcare institutions, and in necessary cases - ambulatory card development (form № 112). In addition, the diagnosis was confirmed by biochemical research, in particular the definition in serum calcium, magnesium, inorganic phosphorus, potassium, sodium, acid-alkaline ratio, the content of the lemon and pyruvic acids, the breakdown of Sulkowice. All children have researched the blood, urine, if necessary, other studies conducted. Has been studied in detail the functional state of different organs and systems using biochemical, ECG and x-ray methods of examination. Clinical and biochemical changes in the body to be considered depending on the severity of the disease. All children with manifestations D-vitamin intoxication were filled with a special map of the survey, which details were recorded clinical data and biochemical research results with regard to the follow-up monitoring and effectiveness of remedial measures.
Table 4 shows the main clinical symptoms of hypervitaminosis D u observed children.
Table 4 shows that D-vitamin poisoning was accompanied by a lesion of a number of organs and systems.

  • Change skin
  • The digestive organs
  • Changes in the cardiovascular system
  • Violation of kidney function
  • The defeat of respiratory organs
  • Laboratory research