Hypervitaminosis a in pediatric hematopoietic stem cell patients requiring renal replacement therapy.

Abstract

BACKGROUND:

Chronic renal failure patients have been known to develop vitamin A toxicity, but a descriptive study of hypervitaminosis A in patients with acute renal failure (ARF) has not yet been published. The authors observed hypervitaminosis A in pediatric hematopoietic stem cell transplant (HSCT) patients.

METHODS:

All HSCT patients admitted between January 2001 and May 2006 who experienced ARF, received renal replacement therapy (RRT), and had a vitamin A level drawn were included in this retrospective, descriptive study. Molar ratios of vitamin A and retinol-binding protein (RBP) were calculated to more accurately assess vitamin A status. Nineteen patients met the criteria for this study.

RESULTS:

At initial testing (generally between days 6 and 10 after initiation of RRT), 17 of the 19 patients had abnormally elevated vitamin A levels for their age. Molar ratios of vitamin A to RBP were elevated in 6 patients at initial testing. Prescribed vitamin A intake information (parenteral and enteral) was available for most patients; all but 3 had an average daily intake greater than 2000 IU/kg over the 30 days prior to RRT initiation. Many patients had symptoms possibly related to vitamin A toxicity, although interpretation of hair, skin, and liver abnormalities are difficult to ascertain in HSCT patients. Seven patients had other findings that may have been associated with vitamin A toxicity.

CONCLUSION:

Children undergoing HSCT who receive nutrition support (predominantly parenteral nutrition), experience ARF, and require RRT are at risk for hypervitaminosis A and toxicity.

• Authors: Ann Connell Lipkin, Polly Lenssen
• Journal: Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition (Nutr Clin Pract) 2008 Dec-2009 Jan Vol. 23 Issue 6 Pg. 621-9 ISSN: 0884-5336 [Print] United States
• PMID: 19033221 (Publication Type: Journal Article)

Chemical References

• Retinol-Binding Proteins
• Vitamin A

Topics

• Acute Kidney Injury (complications, therapy)
• Adolescent
• Child
• Child, Preschool
• Female
• Hematopoietic Stem Cell Transplantation
• Humans
• Hypervitaminosis A (etiology)
• Infant
• Male
• Nutritional Support
• Renal Replacement Therapy (methods)
• Retinol-Binding Proteins (metabolism)
• Retrospective Studies
• Risk Factors
• Time Factors
• Treatment Outcome
• Vitamin A (administration & dosage, adverse effects, blood)