Exogenous intoxication by non-prescribed use of vitamin D, a case report

Abstract

Background This case report, unlike the current literature related to vitamin D intoxication, aims to highlight the risk of self-medication, and how publicity boosts the acquisition of vitamins for different purposes, increasing consumption with no professional indication or supervision. This practice can pose a serious health risk to the population. Case presentation Our patient, a brazilian retired 64-year-old female, presented to the emergency service with post-prandial food vomiting of undigested content and stabbing abdominal pain with worsening during palpation. Concomitantly, onset of sporadic frontal headache, fatigue, hyporexia, weight loss of 18 kg in the same period, severe pruritus, musculoskeletal pain in the limbs and nocturia. The physical examination showed hypertension (160/80 mmHg) and itchy macules in the lower limb. Initially, the main diagnostic hypotheses were multiple myeloma, hyperparathyroidism and pancreatitis secondary to hypercalcemia, osteolytic neoplasms and other neoplasms that present with hypercalcemia. However, blood count, parathyroid hormone, chest X-ray, immunoglobulins, myelogram and bone marrow biopsy were not compatible with these diagnoses. Meanwhile, 25 OH vitamin D dosage and diluted vitamin D test confirmed the diagnosis of hypervitaminosis D. Hypercalcemic crisis was managed with vigorous hydration (50 ml/kg in 2 h), furosemide, bisphosphonates and blood pressure control with amlodipine and atenolol. Subsequently, the patient was discharged from the outpatient clinic with complete remission of symptoms, weight gain, serum calcium values of 10.76 mg/dL and ionizable calcium values of 6.52 mg/dL. Conclusion Our report summarizes the possible consequences of using a vitamin compound without supervision of a competent professional, as these substances are mistakenly considered non-toxic. To add, little information is available about the supplements’ metabolism and their biological effects. Therefore, It is difficult to diagnose intoxication. This case report shows that even the self-administration of a product designed to bring health benefits can become a risky behavior. These vitamin and mineral supplements are supposed to bring patient empowerment and reduce government spending in health-care, but indeed represent a significant public health concern due to possible overdose and drug interactions.

Fallout Following Unproven Prophylactic Use of Exogenous Vitamin D for COVID-19

“…The evolution of hypercalcemia secondary to VDT has been adduced to the increased activity of the more potent/active vitamin D [1,25(OH) 2 D] [10,11]. These findings have been documented in similar case reports [12][13][14][15].…”

“…In the renal system, hypercalcemia can induce frequency of micturition by blunting vasopressin effect on the tubules leading to dehydration/polydipsia, precipitation of calcium crystals in the urine (crystalluria), and hypokalemia in association with metabolic alkalosis by inhibiting renal potassium reabsorption [10,11]. Acute kidney injury (AKI) is a frequent manifestation of VDT as reported in the literature [12][13][14][15]. However, for unknown reasons, the index did not present with AKI.…”

Prevalence of Iatrogenic Vitamin D Toxicity Among the Saudi Population of Vitamin D Users Due to Overcorrection

“…Multiple case reports support these findings, including a case report of a female patient who presented with vomiting, severe abdominal pain, and worsening palpitations. After a thorough examination, hypervitaminosis D was diagnosed and corrected [ 23 ]. Similar findings were reported from the Columbia University Medical Center, where nine patients presented with hypercalcemia symptoms.…”

Too much of a good thing: A case series of rare yet pertinent causes of hypercalcaemia and acute kidney injury

“…Treatment involves removal of the causative agent, fluid resuscitation and measures to normalise the adjusted calcium concentration such as bisphosphonates or oral corticosteroids. 7,8 Vitamin and mineral supplements are easily accessible as over-the-counter preparations. Increased public awareness of vitamin D related health benefits might increase the risk of VDT due to self-administration of vitamin D in doses higher than recommended for age and body weight or even higher than the established upper limit intake values.…”

“…Treatment involves removal of the causative agent, fluid resuscitation and measures to normalise the adjusted calcium concentration such as bisphosphonates or oral corticosteroids. 7,8…”