Hypervitaminosis d

Hypervitaminosis D is a disease, which is stipulated by the toxic action of vitamin D and is characterized with intoxication of different degree, affection of organs and systems and development of hypercalcemia.

Diagnostic criteria

/. Clinical:

1. Syndrome of toxicosis:

Toxicosis of 1 degree - decrease of appetite, irritability, disorders of sleep, delay of weight increase, subfebrile temperature.

Toxicosis of 2 degree - pallor of skin, vomits, decreases of weight, functional disorders of internal organs and systems.

Toxicosis of 3 degree - anorexia, persistent vomits, dehydration, considerable loss of weight, complications such as pneumonia, pyelonephritis, myocarditis, and pancreatitis.

2. Syndrome of functional disorders of nervous system: flaccidity, apathy, alternating with excitability, irritability, drowsiness, hyperesthesia, sweating, meningism, encephalitic reactions, depression of consciousness, convulsions.

3. Cardio-vascular syndrome:

tachycardia, muffled cardiac sounds, systolic murmur, cyanosis, dyspnea, enlargement of liver, edemas. ECG disorders - dilation of QRS-complex, lengthening of PQ interval, smoothing of T-wave, diphase T-wave in lead V₄.

4. Gastro-intestinal syndrome:

decrease of appetite up to anorexia, vomit, persistent constipation, rarely diarrhea, enlargement of liver and spleen.

5. Renal syndrome:

dysuric symptoms, polyuria, probably oliguria up to anuria, azotemia.

6. Changes in osseous system:

consolidation of the skull bones, early closure of big fontanel, craniostenosis.

//. Laboratory:

• blood: leucocytosis, elevated ESR;

• biochemical changes: hypercalcemia, hypophosphatemia, hypomagnesemia, hypokalemia, elevated levels of citrates and cholesterin;

• urine: increase of calcium, Sulkowitch’s test is positive;

• stool: neutral fat;

• acid-base equilibrium - metabolic acidosis.

Classification of Hypervitaminosis D

Course	Form	Period
Acute (as neurotoxicosis or toxicosis with dehydration of 1- 3 degree) Chronic	Nervous Gastro-intestinal Renal Cardio-vascular	Clinical manifestations Residual signs

Treatment of Hypervitaminosis D

This depends upon the severity of general condition. Intensive detoxicative therapy includes: i.v. injections of 5% albumin, 5% solution of glucose with Ringer’s solution, cocarboxylase, vit C, prednisolone, vit E, furosemid (1 mg/kg 3 times/d), thyreocalcitonin (75-150 U i.m. every day), 3% solution of ammonium chloride (teaspoonful 3 times a day), almagel, Trilon B 50 mg/kg 2-3 times/d.

It is necessary to exclude food with high concentration of calcium (milk, curds).

Tetany

Tetany is a disease stipulated by the disturbances of mineral metabolism, hypofunction of parathyroid glands and manifesting with elevated excitability of nervous-muscular apparatus and development of clonotonic convulsions.

Diagnostic criteria

/. Anamnestic data:

Wrong formula feeding, abuse of cow milk, goats and flour meals, insufficient stay at the fresh air, absence of rickets’ prevention are revealed in the case history.

//. Clinical signs:

Tetany develops in children suffering from rickets. As a rule, children younger than 2-3 years may be ill both with rickets and tetany.

Clinically we can distinguish latent and manifest tetany.

Symptoms of latent tetany:

1. Chvostec’s symptom - symptom of facial nerve, tapping on the place of outlet of facial nerve causes spastic contraction of mimic facial muscles;

2. Weis’s symptom - irritation of the place of outlet of trigeminal nerve (near the external acoustic meatus) leads to contraction of mimicry muscles;

3. Trousseau’s symptom - squeezing of nerve-vascular bundle on the shoulder causes spastic contraction of hand’s muscles - "obstetrician’s hand";

d) Lust’s symptom - peroneal symptom, tapping lower the head of the fibula causes dorsal flexion and opening of feet’s fingers;

e) Maslov’s symptom - prick on the heel causes apnoe instead of quickening of breathing;

f) Erb’s symptom - closing of cathode on the muscle leads to its spasm while strength of the current is less than 5 mA.

Symptoms of manifest tetany:

a) laryngospasm - convulsive spasm of true glottis during inspiration accompanied by "cock-cry" and development of cyanosis attack;

b) carpo-pedal spasm - tonic convulsions of extremities’ muscles;

3. general tonic convulsions of body’s muscles, mimic muscles (epileptoid convulsions) with unconsciousness;

4. expiratory apnoe - stop of respiration on expiration with development of attack of general cyanosis.

Convulsive spasm of a heart muscle leading to child’s death is possible.

///. Laboratory diagnostics:

Hypocalcemia (to 1,2-1,5 mmol/l), quantity of inorganic phosphorus is relatively elevated. Alcalosis is seen in some children.

Differential diagnosis is conducted with hyperthermic convulsions, complicated pneumonia, meningitis, viral diseases, and epilepsy.