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

Abstract

tBackground: Despite well-documented risks, injectable supplements containing high dosesof 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 theuse of veterinary intramuscular injection supplements of vitamin A, D and E. The patientswere admitted to two referral hospitals in Fortaleza (Brazil) between January 2010 and Jan-uary 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%), weightloss (43.7%), epigastric pain (31.2%) and headache (31.2%). At hospital admission the meanlaboratory values were: hemoglobin 10 ± 2.0 g/dL (6.1–14.2), leukocytes 10,542 ± 4871/mm3(4100–15,100), creatinine 3.9 ± 5.2 mg/dL (0.7–22) and urea 91 ± 88 mg/dL (22–306), respec-tively. 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 was135 ± 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 studyperiod.Conclusions: Excessive use of veterinary vitamin supplements containing high doses of vita-min 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.