A 14-year-old boy named TJ, who recently moved to America with his mother, unknowingly ate 150 gummy vitamins for breakfast, thinking they were candy. Unbeknownst to him, these vitamins contained extremely high amounts of vitamins A and D. The excessive intake led to hypervitaminosis, causing TJ to experience severe symptoms such as stomach pain, muscle weakness, and a broken arm. Upon arrival at the emergency room, TJ slipped into a coma. Further examination revealed that the high levels of vitamin A in his system caused liver damage, hypercalcemia (high calcium levels in the blood), and bone resorption, leading to the weakening of his bones. The case highlights the dangers of excessive nutrient intake and the importance of understanding the differences in food products and supplements between countries. TJ's ultimate outcome is unknown, but he was on the path to recovery when last seen.
Here are the key facts extracted from the text:
1. A 14-year-old boy named TJ ate 150 gummy vitamins for breakfast.
2. TJ presented to the emergency room with muscle weakness, stomach pain, and a broken arm.
3. TJ's mother had moved to America with him after his father left.
4. TJ had been eating 30-40 gummy vitamins per day, thinking they were candy.
5. TJ's mother did not speak English and did not realize the gummies were vitamins.
6. TJ's liver function was normal, but he had liver damage and hypercalcemia.
7. TJ had ascites, a fluid buildup in the abdomen, and dry skin on his legs.
8. A blood test showed that TJ had high levels of calcium in his blood, but no significant elevations in vitamins A-E, iodine, zinc, or selenium.
9. TJ was dehydrated, which was consistent with his profuse urination before falling into a coma.
10. TJ's liver damage was caused by hypervitaminosis A, which was induced by his consumption of gummy vitamins.
11. TJ had an increased number of fat-laden stellate cells in his liver, which indicated that vitamin A had been accumulating for some time.
12. TJ's hypercalcemia was caused by the breakdown of his bones, which was stimulated by the high levels of vitamin A in his body.
13. Vitamin A can block the effect of vitamin D and prevent calcium absorption in the intestines.
14. TJ's consumption of 75,000 units of vitamin D was 188 times the recommended daily value.
15. Vitamin A is metabolized in the body to active retinoic acid, which stimulates osteoclast formation and bone resorption.
16. The largest stores of endogenous calcium are in the bones.
17. TJ's bone resorption had been accumulating since he started eating gummy vitamins, leading to a threshold where a simple fall fractured multiple bones in his arm.
18. The dating of a Homo erectus skeleton coincides with a hypothesized increase in meat consumption in early humans, which may have led to vitamin A intoxication.
19. The mechanism of liver damage, ascites, hypercalcemia, and bone deterioration is the same in TJ as it is in the Homo erectus skeleton.
20. TJ's treatment included draining his ascites with diuretics and advising him on behavioral changes to limit his risk of further fractures.
21. TJ's liver will have to clear the retinal esters on its own, and he will have to bear the pain of his acute and chronic hypervitaminosis A until then.
22. TJ and his mother were only visiting the United States, and their ultimate outcome is unknown.
23. TJ's nail and skin dystrophy were beginning to resolve, and his ascites was diminished at discharge, indicating some recovery of liver damage.
24. TJ realized that the gummies he ate were not actually candy but were really vitamins and ceased taking them.