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Clinical Pediatrics
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Pleural Effusion and Ascites

Unusual Presenting Features in a Pediatric Patient with Vitamin A Intoxication

Henrietta Kotlus Rosenberg

Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

Stuart Berezin

Department of Gastroenterology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

Sydney Heyman

Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

Camillus Witzleben

Department of Pathology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

John B. Watkins

Department of Gastroenterology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

The usual presenting features of vitamin A intoxication are pseuotumor cerebri, skeletal pain, desquamative dermatitis, and hepatic inflammation. Our patient was a nine-year-old female who had increasing cough, dyspnea, and abdominal dis tention for a short time prior to admission. She was said to have been treated with 10,000 units vitamin A per day for skin rashes. Radiographic studies revealed a very large right sided pleural effusion, ascites, demineralized bones, and retarded skeletal maturation. The diagnosis of hypervitaminosis A was made. More detailed medical history confirmed that the child had, in actuality, received up to 300,000 units/day of vitamin A plus desiccated liver pills and carrot juice for the previous year. Clinical symptoms completely abated following acute medical treatment for ascites and cessation of vitamin A intake. Several months later, a sample of liver, obtained and preserved at the time of exploratory laparotomy, was homogenized and extracted with ethanol/hexane. The retinyl palmitate level was significantly elevated and consistent with vitamin A poisoning.

Clinical Pediatrics, Vol. 21, No. 7, 435-440 (1982)
DOI: 10.1177/000992288202100710
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Home page
 Arch Intern MedHome page
D. G. Meyers, P. A. Maloley, and D. Weeks
Safety of Antioxidant Vitamins
Arch Intern Med, May 13, 1996; 156(9): 925 - 935.
[Abstract] [PDF]