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. 1981 Jun 20;282(6281):1999–2002. doi: 10.1136/bmj.282.6281.1999

Vitamin A toxicity and hypercalcaemia in chronic renal failure.

K Farrington, P Miller, Z Varghese, R A Baillod, J F Moorhead
PMCID: PMC1505945  PMID: 6788164

Abstract

Serum vitamin A concentrations were measured in 38 patients undergoing haemodialysis, 24 of whom were taking multivitamin preparations containing vitamin A. Vitamin A concentrations were significantly higher in patients undergoing haemodialysis than in 28 normal controls (p less than 0.001). Patients taking vitamin A supplements had significantly higher vitamin A concentrations than those not taking them (p less than 0.05), and hypercalcaemic patients had higher concentrations than normocalcaemic patients (p less than 0.005). Withdrawal of vitamin A supplements in seven patients caused significant falls in serum vitamin A concentrations and plasma calcium concentrations (p less than 0.01 at two and three months in both cases) and in plasma alkaline phosphatase concentrations (p less than 0.01 at two months). Vitamin A toxicity can contribute to hypercalcaemia in patients undergoing haemodialysis, probably by an osteolytic effect. Multivitamin preparations containing vitamin A should therefore be prescribed with caution in these patients.

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2002

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bassett B. E., Packer L. Response of isolated lysosomes to vitamin A. J Cell Biol. 1965 Nov;27(2):448–450. doi: 10.1083/jcb.27.2.448. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. CAFFEY J. Chronic poisoning due to excess of vitamin A; description of the clinical and roentgen manifestations in seven infants and young children. Am J Roentgenol Radium Ther. 1951 Jan;65(1):12–26. [PubMed] [Google Scholar]
  3. Chertow B. S., Williams G. A., Norris R. M., Baker G. R., Hargis G. K. Vitamin A stimulation of parathyroid hormone: interactions with calcium, hydrocortisone, and vitamin E in bovine parathyroid tissues and effects of vitamin A in man. Eur J Clin Invest. 1977 Aug;7(4):307–314. doi: 10.1111/j.1365-2362.1977.tb01610.x. [DOI] [PubMed] [Google Scholar]
  4. DINGLE J. T. Studies on the mode of action of excess of vitamin A. 3. Release of a bound protease by the action of vitamin A. Biochem J. 1961 Jun;79:509–512. doi: 10.1042/bj0790509. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. FELL H. B., MELLANBY E. Effects of hypervitaminosis A on foetal mouse bones cultivated in vitro; preliminary communication. Br Med J. 1950 Sep 2;2(4678):535–539. doi: 10.1136/bmj.2.4678.535. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Farrington K., Varghese Z., Moorhead J. F. Human calcitonin in the treatment of renal osteodystrophy. J Lab Clin Med. 1980 Aug;96(2):299–306. [PubMed] [Google Scholar]
  7. Frame B., Jackson C. E., Reynolds W. A., Umphrey J. E. Hypercalcemia and skeletal effects in chronic hypervitaminosis A. Ann Intern Med. 1974 Jan;80(1):44–48. doi: 10.7326/0003-4819-80-1-44. [DOI] [PubMed] [Google Scholar]
  8. IRVING J. T. The effects of a vitaminosis and hypervitaminosis A upon the incisor teeth and incisal alveolar bone of rats. J Physiol. 1949 Mar 1;108(1):92–101. doi: 10.1113/jphysiol.1949.sp004312. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Jowsey J., Riggs B. L. Bone changes in a patient with hypervitaminosis A. J Clin Endocrinol Metab. 1968 Dec;28(12):1833–1835. doi: 10.1210/jcem-28-12-1833. [DOI] [PubMed] [Google Scholar]
  10. Kleiner-Bössaler A., Deluca H. F. Formation of retinoic acid from retinol in the kidney. Arch Biochem Biophys. 1971 Jan;142(1):371–377. doi: 10.1016/0003-9861(71)90295-5. [DOI] [PubMed] [Google Scholar]
  11. NEELD J. B., Jr, PEARSON W. N. Macro- and micromethods for the determination of serum vitamin A using trifluoroacetic acid. J Nutr. 1963 Apr;79:454–462. doi: 10.1093/jn/79.4.454. [DOI] [PubMed] [Google Scholar]
  12. RAISZ L. G. BONE RESORPTION IN TISSUE CULTURE. FACTORS INFLUENCING THE RESPONSE TO PARATHYROID HORMONE. J Clin Invest. 1965 Jan;44:103–116. doi: 10.1172/JCI105117. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. STANBURY S. W., LUMB G. A. Metabolic studies of renal osteodystrophy. I. Calcium, phosphorus and nitrogen metabolism in rickets, osteomalacia and hyperparathyroidism complicating chronic uremia and in the osteomalacia of the adult Fanconi syndrome. Medicine (Baltimore) 1962 Feb;41:1–34. [PubMed] [Google Scholar]
  14. Smith F. R., Goodman D. S. The effects of diseases of the liver, thyroid, and kidneys on the transport of vitamin A in human plasma. J Clin Invest. 1971 Nov;50(11):2426–2436. doi: 10.1172/JCI106741. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Varghese Z., Moorhead J. F., Tatler G. L., Baillod R. A., Wills M. R. Plasma hydroxyproline in renal osteodystrophy. Proc Eur Dial Transplant Assoc. 1973;10(0):187–196. [PubMed] [Google Scholar]
  16. Werb R., Clark W. F., Lindsay R. M., Jones E. O., Linton A. L. Serum vitamin A levels and associated abnormalities in patients on regular dialysis treatment. Clin Nephrol. 1979 Aug;12(2):63–68. [PubMed] [Google Scholar]
  17. Wieland R. G., Hendricks F. H., Amat y Leon F., Gutierrez L., Jones J. C. Hypervitaminosis A with hypercalcaemia. Lancet. 1971 Apr 3;1(7701):698–698. doi: 10.1016/s0140-6736(71)92702-4. [DOI] [PubMed] [Google Scholar]
  18. Yatzidis H., Digenis P., Fountas P. Hypervitaminosis A accompanying advanced chronic renal failure. Br Med J. 1975 Aug 9;3(5979):352–353. doi: 10.1136/bmj.3.5979.352. [DOI] [PMC free article] [PubMed] [Google Scholar]

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