Acute kidney injury due to excessive and prolonged intramuscular injection of veterinary supplements containing vitamins A, D and E: A series of 16 cases

作者：Daher Elizabeth De Francesco^*; Mesquita Martiniano Lorena Vasconcelos; Lopes Lima Laio Ladislau; Viana Leite Filho Newton Carlos; de Oliveira Souza Louize Emanuele; Palacio Duarte Fernandes Paulo Henrique; da Silva Sonia Leite; da Silva Geraldo Bezerra Junior

来源：Nefrologia, 2017, 37(1): 61-67.

DOI：10.1016/j.nefro.2016.05.017

• Acute kidney injury
• Vitamin supplements
• Hypercalcaemia

Background: Despite well-documented risks, injectable supplements containing high doses of vitamins are commonly used. Objectives: To describe acute kidney injury (AKI) as a complication of vitamin intoxication.
Methods: Our series consisted of 16 patients with kidney complications resulting from the use of veterinary intramuscular injection supplements of vitamin A, D and E. The patients were admitted to two referral hospitals in Fortaleza (Brazil) between January 2010 and January 2015.
Results: Patients' mean age was 28.3 +/- 8.9 years (19-53 years), and 11 (68.7%) were male. Main signs and symptoms upon admission were nausea (68.7%), vomiting (62.5%), weight loss (43.7%), epigastric pain (31.2%) and headache (31.2%). At hospital admission the mean laboratory values were: hemoglobin 10 +/- 2.0 g/dL (6.1-14.2), leukocytes 10,542 +/- 4871/mm(3) (4100-15,100), creatinine 3.9 +/- 5.2 mg/dL (0.7-22) and urea 91 +/- 88 mg/dL (22-306), respectively. Serum calcium was 12 +/- 2.2 mg/dL (8.8-15.5), 24-h urine calcium was 575 +/- 329 mg (10.7-1058), serum PTH was 55 +/- 141 pg/mL (2-406), and serum vitamin D concentration was 135 +/- 75 ng/mL (22-265). Using KDIGO criteria, AKI was diagnosed in 13 patients (81.2%), classified as stage 1 (n=3), stage 2 (n=3) or stage 3 (n=7). No deaths occurred in the study period.
Conclusions: Excessive use of veterinary vitamin supplements containing high doses of vitamin A, D and E was associated with AKI. Hypercalcaemia, which was a common finding, appears to be a contributing factor to the development of this type of AKI.

• 出版日期2017-2