Here is a concise summary of the story:
**Title:** Accidental Hypervitaminosis A Poisoning from Gummy Vitamins
**Case:**
* 14-year-old boy (TJ) eats 150 gummy vitamins for breakfast, thinking they were candy
* Unbeknownst to him and his non-English speaking mother, these were highly concentrated vitamins
* TJ experiences severe symptoms: muscle weakness, stomach pain, broken arm, and slips into a coma
**Medical Findings:**
* Diagnosed with Hypervitaminosis A (excessive Vitamin A intake)
* Liver damage (hepatotoxicity) and hypercalcemia (elevated calcium levels in blood)
* Vitamin A overdose caused bone resorption, leading to weakened bones and fractures
**Treatment & Outcome:**
* Emergency treatment for hypercalcemia and liver damage
* Discharged with some recovery, but long-term outcome unknown due to missed follow-up appointment
* Immediate cessation of vitamin intake crucial for recovery
Here are the extracted key facts, each with a number and in short sentences, excluding opinions:
**Patient Information**
1. TJ is a 14-year-old boy.
2. TJ and his mother moved to America after his father's departure.
3. Neither TJ nor his mother spoke English when they arrived.
**Incident and Symptoms**
4. TJ ate 150 gummy vitamins for breakfast one morning.
5. About an hour later, TJ experienced profuse urination and severe stomach pain.
6. TJ broke his arm after falling due to weakness.
7. TJ lost consciousness and slipped into a coma upon arrival at the emergency room.
**Medical Findings**
8. Initial diagnosis was mistaken for a mere bone fracture due to low priority triage.
9. Physical examination revealed dry skin, fractured nails, and ascites (fluid buildup causing a swollen stomach).
10. Blood tests indicated normal liver function but high calcium levels (hypercalcemia).
11. Further testing showed no significant elevations in vitamins A through E, iodine, or selenium.
12. TJ was dehydrated, consistent with his profuse urination.
**Vitamin-Related Findings**
13. TJ consumed 187,000 IU of vitamin A in one sitting (63 times the recommended daily amount).
14. His typical daily intake of 30-40 gummy vitamins exceeded 20 times the recommended daily dose of vitamin A.
15. TJ also consumed 75,000 units of vitamin D (188 times the recommended daily value).
**Liver and Bone Damage**
16. Transjugular liver biopsy revealed increased fat-laden stellate cells, indicating vitamin A accumulation in the liver.
17. Vitamin A induced hepatotoxicity was diagnosed, causing liver damage.
18. Excess vitamin A led to bone resorption, causing hypercalcemia and contributing to TJ's broken arm.
**General Facts and History**
19. In the 1950s, milk fortification with vitamin D led to cases of hypercalcemia in infants in Britain.
20. High vitamin A intake has been linked to lower bone mineral density and increased risk of hip fractures (epidemiological surveys in Sweden and Norway).
21. Polar bear liver contains extremely high levels of vitamin A (identified as the toxic component in 1942).
22. Ancient human skeletons (e.g., Homo Erectus in Kenya, circa 1.5 million years ago) show signs of vitamin A intoxication affecting bone integrity.