Adult Hypervitaminosis D-A Case Series

Abstract

Prolonged hypervitaminosis D can result in calcium deposition in the soft tissues (especially the kidneys and heart), changes in the central nervous system & in severe cases, death. Patients and clinicians considering supplementation above currently recommended levels should be made aware of the possible toxicities of treatment with vitamin D, and baseline calcium and parathyroid hormone and vitamin D levels should be ascertained. We report here 8 such cases, all presenting with nausea, vomiting, polyuria, polydipsia, weakness and the common history of administration of vitamin D for backache, osteoarthritis, osteoporosis, leg cramps or generalized weakness. Laboratory tests revealed hypercalcemia and hypervitaminosis D in all cases. Vitamin D intoxication from increase in vitamin D intake may have become frequent in recent years due to an understanding of the role of 25-hydroxy vitamin D in the pathogenesis of several diseases. The importance of this case series as a warning against overtreatment and unnecessary treatment with high dose vitamin D cannot be overemphasized, especially as a public health measure in a country where vitamin D deficiency in children manifesting with rickets is a risk.

Hypervitaminosis D in Kashmiri Population: A Case Series of 11 Patients

“…In our study,all the patients had vitamin D toxicity with symptoms of hypercalcemia due to excess intake of vitamin D in the form of injections or sachets (all patients had vitamin D levels beyond 100ng/ml which is much higher than normal levels 17,19 ) .All other causes like malignancy and other granulomatus diseases were ruled out.Serum parathyroid hormone levels were on lower or normal side which rules out hyperparathyroidism 17 .Dietary excess more than normal recommended intake(400-800IU) 26 was unlikely in our study because there was no such history of consumption of dietary products with excess vitamin D or vitamin D fortified foods,moreso C-1 hydroxylation of vitamin D is so tightly regulated that non-hydroxylated prohormones of vitamin D found in diet are less likely to cause toxicity than hydroxylated active pharmaceutical products of vitamin D,unless dietary products are taken in large doses as in the study of Nussey S et al 28 .Elderly and postmenopausal females were the majority of the patients in our study due to decreased renal function in old people and reduced ability to excrete excess calcium,and excess intake of vitamin D and calcium in postmenopausal females for osteoporotic back and other joint pains, leads to vitamin D toxicity as also mentioned by Moushmi Lodh et al 29 .As vitamin D is stored in fat, hypercalcemia can develop over a long period and also it can remain for many years 30 , as in some of our patients who developed the toxicity over years. Hypercalcemia, normal or high phosphate levels, normal or low levels of alkaline phosphatase, high levels of vitamin D,low parathriod levels and high urea and creatinine levels are found in hypervitaminosis D 31 ,as also found in our study in majority of patients.…”