Vitamin D intoxication due to misuse: 5-year experience

INTRODUCTION

Vitamin D intoxication (VDI) is a well-known cause of hypercalcemia in children and leads to serious kidney, heart, and neurological problems. In the treatment of VDI, the goal is to correct hypercalcemia. Our aim was to evaluate the clinical features of patients with VDI, identify the causes of VDI in our region, and help guide precautions and treatment of VDI.

MATERIALS AND METHODS

The medical records of patients with VDI presenting between January 2015 and December 2019 were retrospectively analyzed.

RESULTS

In total, 38 patients aged 0.3-4 years including 20 males (52.6%) were included in the study. Vomiting (65.8%), loss of appetite (47.4%), and constipation (31.6%) were the most common symptoms. The cause of intoxication was prescribed D₃ vials in 23 patients, non-prescribed D₃ vials in nine patients, and incorrectly produced fish oil supplement in six patients. Admission serum calcium and 25 (OH) D levels were 3.75±0.5mmol/L and 396±110ng/mL, respectively. A statistically significant correlation was found between the serum calcium levels at the time of diagnosis and the dose of vitamin D received, serum 25 (OH) D, phosphorus, and parathyroid (PTH) levels. Nephrocalcinosis was present in 15 (39.5%) patients. The mean time to achieve normocalcemia was 6.18±2 days. The mean time to achieve normocalcemia in patients treated with pamidronate was 5.94±0.7 days.

CONCLUSION

Stoss therapy should not be administered for children of families with problems of adherence to treatment. It should be noted that VDI may develop as a result of improperly produced nutritional supplements. General practitioners and pediatricians must be aware of VDI risks and explain them to parents. Pamidronate is effective for treating VDI in children.

Efficacy of Early Noninvasive Ventilation in Three Cases of Nonfatal Drowning with Pulmonary Oedema in the Paediatric Emergency Department

Drowning is still one of the most important causes of the preventable mortality worldwide. Some patients should be treated with noninvasive ventilation immediately in the emergency department (ED). The practice of noninvasive ventilation has been increased recently in the paediatric ED. We present here three nonfatal drowning patients with pulmonary oedema and hypoxia who were successfully treated with noninvasive ventilation in the paediatric emergency department. All of the patients had aspirated sea water during swimming. In addition, two of the patients had aspirated water during snorkeling. Noninvasive ventilation was applied to the patients immediately in paediatric emergency service. All of the patient's clinical and radiological findings recovered rapidly. There are limited reports about use of noninvasive ventilation in nonfatal drowning cases in the paediatric emergency department. We emphasize that the early application of noninvasive ventilation should be a preventive method for reducing the morbidity of nonfatal drowning cases. (Hong Kong j.emerg.med. 2016;23:42-46)

Knowledge, perspectives and attitudes about allergen-specific immunotherapy for respiratory allergic disease among paediatricians in Turkey

BACKGROUND

Allergen-specific immunotherapy (ASI) is the only effective treatment for allergic respiratory diseases which has the potential to change the natural course of the disease. In this present study we aimed to evaluate the paediatricians' knowledge, perspectives and attitudes about ASI for allergic respiratory diseases.

MATERIALS AND METHODS

The study was conducted between September 2014 - January 2015. A survey of 25 questions assessing paediatricians' knowledge, perceptions and attitudes about ASI was developed by an expert panel and applied by physicians in hospitals in Izmir, Turkey, where the paediatricians work. Data were recorded in SPSS for Windows v.16. Descriptive statistics, chi square analysis was used. P<0.05 was considered as significant.

RESULTS

Fully completed surveys from 180 paediatricians were analysed. The respondent paediatricians had an age of 37±8.2 years, and 56 of them were male. The majority of the respondents (n: 146) were working fewer than five years as a paediatric specialist. 93.9% of the paediatricians believed that ASI was effective for the treatment of allergic respiratory diseases. There was satisfactory knowledge of the characteristics, aims, effects and limits of ASI.

CONCLUSION

ASI is generally well-known and accepted among paediatricians. A better synergy between paediatricians and paediatric allergy specialists can provide more use of this treatment method for allergic respiratory diseases in childhood.

Effects of Different Fruits and Storage Periods on Microbiological Qualities of Fruit-Flavored Yogurt Produced in Turkey

Comparative microbiological analyses of fruit-flavored yogurt, plain yogurt, and plain yogurt with 8% sugar were conducted in this research. The fruit-flavored yogurts were produced from evaporated cow's milk (19.75% dry matter) containing 16% jam prepared with an equal weight of sugar and fruit (sour cherry, orange, strawberry, or banana). The total plate count, lactic acid and coliform bacteria, and yeast and mold counts were determined in yogurt samples stored for 1, 3, 5, 7, 9, and 13 days. In conclusion, it is suggested that these types of yogurt should not be stored longer than 7 days, because when a carryover culture is used for yogurt production, most likely yeast contamination will occur. Otherwise, pure starter culture should be utilized in yogurt production.