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Hypervitaminosis A in Pediatric Hematopoietic Stem Cell Patients Requiring Renal Replacement Therapy

From Seattle Childrens Hospital and Regional Medical Center, Seattle, Washington.

Correspondence: Address correspondence to: Anne C. Lipkin, Seattle Childrens Hospital and Regional Medical Center, Clinical Nutrition, W-3726 Seattle, WA 98105; e-mail: ann.lipkin{at}seattlechildrens.org; alipki{at}u.washington.edu.

Background: Chronic renal failure patients have been known to develop vitamin A toxicity, but a descriptive study of hypervitaminosis A in patients with acute renal failure (ARF) has not yet been published. The authors observed hypervitaminosis A in pediatric hematopoietic stem cell transplant (HSCT) patients. Methods: All HSCT patients admitted between January 2001 and May 2006 who experienced ARF, received renal replacement therapy (RRT), and had a vitamin A level drawn were included in this retrospective, descriptive study. Molar ratios of vitamin A and retinol-binding protein (RBP) were calculated to more accurately assess vitamin A status. Nineteen patients met the criteria for this study. Results: At initial testing (generally between days 6 and 10 after initiation of RRT), 17 of the 19 patients had abnormally elevated vitamin A levels for their age. Molar ratios of vitamin A to RBP were elevated in 6 patients at initial testing. Prescribed vitamin A intake information (parenteral and enteral) was available for most patients; all but 3 had an average daily intake greater than 2000 IU/kg over the 30 days prior to RRT initiation. Many patients had symptoms possibly related to vitamin A toxicity, although interpretation of hair, skin, and liver abnormalities are difficult to ascertain in HSCT patients. Seven patients had other findings that may have been associated with vitamin A toxicity. Conclusion: Children undergoing HSCT who receive nutrition support (predominantly parenteral nutrition), experience ARF, and require RRT are at risk for hypervitaminosis A and toxicity.

Key Words: hypervitaminosis A • vitamin A • bone marrow transplantation • acute kidney failure • renal insufficiency • kidney diseases • renal dialysis • renal replacement therapy • hemodiafiltration • dialysis • renal dialysis • critical care • intensive care • pediatric intensive care units

Nutrition in Clinical Practice, Vol. 23, No. 6, 621-629 (2008)
DOI: 10.1177/0884533608327082


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