Case presentationA 73-year-old man presented with a 4-week history of diarrhoea and 2-week history of confusion. He was a retired nuclear scientist who was previously fully independent with no history of cognitive impairment. There was no history of smoking, alcohol or substance abuse.His wife reported cognitive disturbances including being unable to use a cassette player or turn on his electric razor and he had started urinating in the sink. He was visited by his GP who found him confused, drowsy and dehydrated. Observations were unremarkable but a rectal examination showed hard stool in the rectum. Presuming a urinary tract infection, laxatives and trimethoprim were prescribed and he was transferred to hospital for further investigations.On admission there were no infective signs or symptoms. His cardiovascular, respiratory and abdominal examinations were unremarkable. He was extremely delirious requiring sedation and occasional reasonable physical restraint. He scored 3/10 on the Abbreviated Mental Test Score (AMTS) but had no other neurological signs. His electrocardiogram (ECG), chest X-ray (CXR) and computed tomography (CT) brain were all normal. Admission blood test results are shown in Table 1 . DiagnosisInvestigations for his hypercalcaemia revealed low parathyroid hormone 0.6 pmol/L and a toxic 25-hydroxyvitamin D (25[OH]D) ABSTRACT concentration 881 nmol/L (normal range 25-100 nmol/L), suggesting a diagnosis of hypervitaminosis D. Other causes of hypercalcaemia such as malignancy, thyroid disease and sarcoidosis were excluded. On further questioning his daughter reported he had been taking 60,000 IU vitamin D capsules per day for the last 2 years having read a book advocating its health benefits.
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