162 VITAMINS A AND CAROTENES 



toxicity due to an excess intake of vitamin A has been recognized in young- 

 children. In view of the increasing usage of oleum percomorphum, halibut 

 liver oil, and other highly potent preparations of vitamin A, it is not sur- 

 prising that overzealous or careless parents and grandparents have been 

 responsible for the appearance of a new clinical syndrome. The causal fac- 

 tors vary — -careless measurement of concentrates, failure to distinguish be- 

 tween potent concentrates and cod liver oil or between drops and teaspoons 

 as measures of dosage, and the idea that if a small amount of a concentrate 

 is good for the child a larger amount should be better. 



Since 1944, when Josephs^^ first recognized the syndrome of hypervita- 

 minosis A in man, ten reports have appeared recording 19 cases, all in the 

 United States. Seven of these were reported in 1950 by CafTey,^"' who pre- 

 sents an excellent description of the symptomatology and roentgenographic 

 features and reviews 8 cases previously reported in the literature. Since 

 then 2 cases have been reported by Gribetz et al.,^^ (who present a tabular 

 summary of 14 cases previously reported) and 1 case each by Berrey*^ and 

 Bair.^* Probably many other instances have occurred in which symptoms 

 were not severe enough to be called to the attention of a physician, or in 

 which a correct diagnosis was not made. 



The age of the 19 patients ranged from 12 to 37 months. The estimated 

 vitamin A intake varied from 75,000 to 500,000 LIT. per day, generally 

 over a period of 3 to 6 months. The chief symptoms were: anorexia, hyper- 

 irritability, painful but minimal soft tissue swellings over areas of skeletal 

 exostoses of long bones, limited motion of extremities, cortical thickening 

 of long bones, sparsity of scalp hair, pruritic rash, and hepatomegaly with- 

 out splenomegaly. Vitamin A plasma levels were exceptionally high and a 

 valuable diagnostic feature, equaled only by the dramatic and rapid disap- 

 pearance of symptoms within a week or so following discontinuation of 

 vitamin A supplements. Since recovery has always been complete, nothing 

 is known regarding histopathologic changes in bone and visceral organs. 

 Discontinuation of the vitamin resulted in recovery, usually in a week or so, 

 in all cases. There is as yet no direct evidence that hypervitaminosis A 

 induces in the bone and other tissues of infants changes which are compar- 

 able to those observed in experimental animals. It seems reasonable to as- 

 sume such would be the case if the hypervitaminotic A state persisted for 

 a sufficient period of time. 



In man, prolonged and excessive intake of vegetables high in carotene, 



79 H. W. Josephs, Am. J. Diseases Children 67, 33 (1944). 



80,1. Caffey, Am. J. Roentgenol. Radium Therapy 65, 12 (1951); I'edialrics 5, 672 



(1950). " 

 " D. Gribetz, S. H. Silverman, and A. E. SoI)cl, Pediatrics 7, 372 (1951). 



82 B. H. Berrey, Pediatrics 6, 78 (1950). 



83 G. Bair, J. Am. Med. Assoc. 146, 1573 (1951). 



