Little Rock Family Practice Clinic

Objective. To report a case of severe hypercalcemia, exacerbatedby vitamin A supplementation and hydrochlorothiazide, in a patient with primaryhyperparathyroidism. Methods. Clinical and laboratory findingsare presented along with response to therapy. Results. A68-year-old white female presented to the emergency department complaining ofnausea, vomiting, and altered mental status. Laboratory findings revealedcalcium 15.8 mg/dL (8.4-10.2), albumin 4.1 g/dL (3.8-4.8), and parathyroidhormone 62 pg/mL (14-64). Serum calcium improved after intravenous hydrationwith normal saline. Prior to this hospitalization, over-the-counter medicationswere significant for calcium (600 mg daily), vitamin A (11 000 IU daily), andvitamin D (800 IU daily).The patient’s prescription medications were significantfor hydrochlorothiazide (12.5 mg daily). Twenty-four-hour urine calcium wassubsequently found to be 146 mg (35-250). Myeloma, lymphoma, and sarcoidosiswere ruled out as the etiology for hypercalcemia. The diagnosis of primaryhyperparathyroidism was confirmed. She was treated surgically for primaryhyperparathyroidism. The right and left superior parathyroid showedhypercellular parathyroid on pathology. The patient was normocalcemic aftersurgery. Conclusion. Previous reports suggest that very highdoses of vitamin A is required to cause hypercalcemia. This case suggests thatin a setting of primary hyperparathyroidism and hydrochlorothiazide therapy,vitamin A may contribute to the development of severe hypercalcemia in patientswho are on calcium and vitamin D supplements. Given their biologic effects,public awareness needs to be created regarding the injudicious use ofvitamins.

BackgroundInternational Task Force (ITF) guidelines established a grading scheme to support treatment of dry eye disease based on clinical signs and symptoms. The purpose of this study was to assess the impact of dry eye on vision-related function across ITF severity levels using the Ocular Surface Disease Index (OSDI) questionnaire.MethodsNon-interventional, cross-sectional study of prescription treatment-naïve dry eye patients seeking symptom relief at 10 ophthalmology and optometry practices. Clinicians assessed corneal and conjunctival staining, tear break-up time, Schirmer’s test (type I with anesthesia), and best-corrected visual acuity. Patients completed the OSDI questionnaire and OSDI overall and domain (Symptoms, Visual Function, and Environmental Triggers) scores were compared across ITF guidelines severity levels (1–4).ResultsOf 158 patients (mean age, 55 years) enrolled, 52 (33%) were ITF level 1, 54 (34%) ITF level 2, and 52 (33%) ITF levels 3/4 combined. No significant differences were observed in most baseline characteristics. Overall OSDI scores (mean [standard deviation]) were 26.5 [20.0] for ITF level 1, 33.8 [17.5] for ITF level 2, and 44.9 [26.1] for ITF level 3/4 cohorts (P < 0.0001). Component OSDI Symptoms, Visual Function, and Environmental Triggers domain scores all worsened with increasing ITF severity level (P ≤ 0.01).ConclusionsDry eye disease has significant deleterious impact on vision-related function across all ITF severity levels.

To assess the efficacy and safety of lansoprazole in the treatment of adolescents with symptomatic, endoscopically proven, non-erosive gastroesophageal reflux disease and erosive esophagitis. Adolescents between 12 and 17 years of age with esophagitis were enrolled in this open-label trial and treated with lansoprazole 15 mg (non-erosive) or 30 mg (erosive) once daily for 8 weeks. If unhealed at week 8, those with erosive esophagitis were treated with an additional 4 weeks of lansoprazole 30 mg once daily. Lansoprazole produced a significant reduction from baseline in the median percentage of days with reflux symptoms (91 to 43% in the 64 adolescents with non-erosive disease and 85 to 16% in the 23 adolescents with erosive esophagitis, P < or = 0.001 for each comparison). At week 8, mucosal healing had occurred in 95% (21 of 22) of those with erosive esophagitis. Treatment-related adverse events were reported by 19% of patients with non-erosive and 4% of patients with erosive esophagitis. Headache (7%), abdominal pain (5%), nausea (3%) and dizziness (3%) were the most frequently reported adverse events. One patient discontinued treatment early because of dizziness and vomiting. An elevation in mean serum gastrin from baseline (59 pg/mL at pretreatment to 80 pg/mL at final visit) was observed. Lansoprazole 15 mg or 30 mg once daily reduced symptoms of gastroesophageal reflux in adolescents with non-erosive gastroesophageal reflux disease and erosive esophagitis, respectively. Lansoprazole 30 mg once daily for 8 weeks was effective in healing erosive esophagitis. Both treatment regimens were considered safe.