Hypercalcemia from hypervitaminosis A in a child with autism

Shannon O’Neal; Timothy P. Foster; Avni Bhatt; Michele N. Lossius; Kristin Dayton

doi:10.1515/jpem-2020-0075

Article

Hypercalcemia from hypervitaminosis A in a child with autism

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Published/Copyright: July 13, 2020

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From the journal Journal of Pediatric Endocrinology and Metabolism Volume 33 Issue 8

Abstract

Objectives

Vitamin A is essential for normal cellular physiology and is often taken as a dietary supplement. Hypervitaminosis A can lead to hypercalcemia by increasing osteoclasts and subsequent bone resporption. Dietary supplements including vitamin A are new popular treatment stategies for autism.

Case presentation

We report a five-year old boy with autism spectrum disorder presenting with severe abdominal pain and bilateral lower extremity pain, who was found to have persistent hypercalcemia due to hypervitaminosis A. The patient ingested over 700 times the recommended intake of Vitamin A per day for age. Retention of vitamin A in the liver and adipose tissue causes toxic levels of retinoids and hypercalcemia.

Conclusions

Acute treatment included intravenous rehydration, furosemide, and calcitonin. Pamidronate was the definitive treatment for hypercalcemia from hypervitaminosis A due to its osteoclast inhibition and long biologic half-life. Parents should be counseled on risks of toxicity and absence of evidence showing benefits of vitamin A therapy for autism.

Keywords: autism spectrum disorder; hypercalcemia; hypervitaminosis A

Corresponding author: Timothy P. Foster, MD, Department of Pediatrics, University of Florida, PO Box 100296, Gainesville, FL, 32610, USA, Phone: +1 (352) 273 5570, Fax: +1 (352) 294 8060, E-mail: tpfoster@ufl.edu

Acknowledgment

The authors have no additional contributors to acknowledge.

Research funding: No external funding was required for this manuscript.
Author Contributions: Dr. Foster and Dr. O’Neal treated the patient and drafted the initial manuscript. Dr. Bhatt critically reviewed and revised the manuscript. Dr. Lossius and Dr. Dayton treated the patient and critically reviewed the manuscript. All authors provided important intellectual content to the final manuscript as submitted and agree to be accountable for all aspects of the work.
Competing interests: The authors have no conflicts of interest to declare.
Informed consent: The patient’s caregivers provided written consent for publication of this case report including publication of images.
Ethical approval: The patient’s caregivers provided written consent for publication of this case report including publication of images.

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Received: 2020-02-19

Accepted: 2020-04-04

Published Online: 2020-07-13

Published in Print: 2020-08-27

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Articles in the same Issue

https://doi.org/10.1515/jpem-2020-0075

Keywords for this article

autism spectrum disorder; hypercalcemia; hypervitaminosis A