Intoxicación por sobredosificación de vitamina D en un lactante / Poisoning by overdose of vitamin d in an infant

El objetivo de esta nota técnica es la descripción y comentarios de un caso clínico reciente de intoxicación por sobredosificación por vitamina D, y la correcta interpretación clínica y de los parámetros de laboratorio. Caso clínico. Lactante de 6 meses en tratamiento con Biominol® (suplemento vitamínico), ingresó debido a un estado de decaimiento e irritabilidad. Las analíticas iniciales muestran concentraciones de calcio iónico en sangre de 2,11mmol/L (intervalo de referencia (IR): 1,15-1,29mmol/L), y concentración de calcio total plasmático de 5,5mmol/L (IR: 2,25-2,75mmol/L). En nuestro laboratorio, las vitaminas D2 y D3 fueron determinadas por cromatografía líquida de alta resolución (HPLC), y por un método electroquimioluminiscente, que mide la vitamina D total. Los valores de vitamina D2 fueron 419ng/mL y vitamina D total 482ng/mL (IR: 30-100ng/mL). La intoxicación de vitamina D tuvo origen exógeno, debido al incremento de vitamina D2. El diagnóstico definitivo fue hipercalcemia severa secundaria a intoxicación por vitamina D y nefrocalcinosis secundaria a esta con función renal normal con hipercalciuria. Como conclusión, cabe destacar la importancia de la correcta dosificación de los pacientes y la determinación de las diferentes formas de vitamina D para averiguar su origen, realizando una correcta interpretación (AU)

The objective of this technical note describes and comments on a recent clinical case of poisoning by overdose of vitamin D, and the correct interpretation of clinical and laboratory parameters. Vitamin D is a fat-soluble vitamin involved in the absorption of calcium and phosphorus in the intestine. Administration of high doses for prolonged periods can cause hypercalcemia, leading to kidney failure and renal calcifications. Clinical case. The definitive diagnosis of this patient was severe hypercalcemia secondary to exogenous vitamin D poisoning, and nephrocalcinosis secondary to this with normal renal function with hypercalciuria. In conclusion, the correct dosing of patients and determination of different forms of vitamin D to trace its origin and making a correct interpretation is important. Male, 6 months old in treatment with Biominol® (vitamin D supplement), was admitted to the emergency department because of a state of decline and irritability. The initial analytical results showed an ionized calcium concentration in blood of 2.11mmol/L (reference interval (RI): 1.15 - 1.29mmol/L), and plasma total calcium concentration of 5.5mmol/L (RI: 2.25-2.75mmol/L). In our laboratory, Vitamin D2 and D3 were determined by liquid chromatography high resolution (HPLC), and an electrochemiluminescence method. The results showed a vitamin D2 419ng/mL and total vitamin D 482ng/mL (RI: 30-100ng/mL). It was found that the vitamin D overdose was of exogenous origin, due to increased vitamin D2 (AU)

Seemingly paradoxical seasonal influences on vitamin D status in nursing-home elderly people from a Mediterranean area.

OBJECTIVE: We investigated vitamin D status in institutionalized elderly subjects by measuring serum 25-hydroxyvitamin D (25[OH]D) and its association with season and other factors: age, gender, nutritional status, cognitive function, functional ability, dietary intake, vitamin D supplement consumption, and disease. METHODS: The cross-sectional study included 86 subjects, 65-94 y of age (29 men and 57 women), who lived in three nursing homes in Murcia, a Spanish Mediterranean area. The Mini Nutritional Assessment, Short Portable Mental Status Questionnaire, and BI were used to evaluate nutritional status, functional ability, and cognitive function, respectively. Serum 25(OH)D concentrations were used to assess vitamin D status. The thresholds of inadequacy were considered to be <25 nmol/L (vitamin D deficiency) and <50 nmol/L (vitamin D insufficiency). RESULTS: Body mass index was 28.8 +/- 5.8 kg/m(2) (mean +/- SD). Vitamin D dietary intake was very much below the recommended dietary intake. The Mini Nutritional Assessment was 23.6 +/- 4.0, cognitive function was 7.8 +/- 1.9, and functional ability 82.9 +/- 23.1. The percentages of subjects with inadequate serum 25(OH)D concentrations were 58.2% and 32.6%, taking into consideration cutoffs of 50 and 25 nmol/L, respectively. Vitamin D deficiency was more common in women (40.3%) than in men (20.7%). Serum 25(OH)D concentrations varied significantly with the season in which the samples were taken, but not with the other factors analyzed. CONCLUSION: In this Mediterranean area, a substantial percentage of institutionalized subjects showed an inadequate vitamin D status, which could be remedied by the consumption of vitamin D-fortified foods and/or vitamin D supplements, especially during the summer months.

Detección de eosinófilos en procesos alérgicos mediante la tinción de Hansel / Detection of eosinophils in processes by Hansel's staining

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Meningitis aguda recidivante / Recurrent bacterial meningitis

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