Vitamin D intoxication and severe hypercalcaemia complicating nutritional supplements misuse

Alkundi, Alamin; Momoh, Rabiu; Musa, Abdelmajid; Nwafor, Nkemjika

doi:10.1136/bcr-2022-250553

Cited by 10 publications

(4 citation statements)

References 7 publications

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“…Vitamin D had previously been reported to protect from neointimal hyperplasia [10,11,20,21], although not by all authors [22]. However, the therapeutic use of vitamin D is marred by potential adverse effects on calcium-phosphate metabolism, as overdosing can cause hypercalcemia, hyperphosphatemia, hypercalciuria, urolithiasis, nephrocalcinosis and kidney failure [29][30][31][32]. Thus, VDR agonists, such as paricalcitol, that have a milder impact on serum calcium and phosphate [33], may be of interest to design novel clinical studies.…”

Section: Discussionmentioning

confidence: 99%

Paricalcitol Has a Potent Anti-Inflammatory Effect in Rat Endothelial Denudation-Induced Intimal Hyperplasia

Baeza,

Pintor-Chocano,

Carrasco

et al. 2024

IJMS

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Neointimal hyperplasia is the main cause of vascular graft failure in the medium term. Vitamin D receptor activation modulates the biology of vascular smooth muscle cells and has been reported to protect from neointimal hyperplasia following endothelial injury. However, the molecular mechanisms are poorly understood. We have now explored the impact of the selective vitamin D receptor activator, paricalcitol, on neointimal hyperplasia, following guidewire-induced endothelial cell injury in rats, and we have assessed the impact of paricalcitol or vehicle on the expression of key cell stress factors. Guidewire-induced endothelial cell injury caused neointimal hyperplasia and luminal stenosis and upregulated the expression of the growth factor growth/differentiation factor-15 (GDF-15), the cytokine receptor CD74, NFκB-inducing kinase (NIK, an upstream regulator of the proinflammatory transcription factor NFκB) and the chemokine monocyte chemoattractant protein-1 (MCP-1/CCL2). Immunohistochemistry confirmed the increased expression of the cellular proteins CD74 and NIK. Paricalcitol (administered in doses of 750 ng/kg of body weight, every other day) had a non-significant impact on neointimal hyperplasia and luminal stenosis. However, it significantly decreased GDF-15, CD74, NIK and MCP-1/CCL2 mRNA expression, which in paricalcitol-injured arteries remained within the levels found in control vehicle sham arteries. In conclusion, paricalcitol had a dramatic effect, suppressing the stress response to guidewire-induced endothelial cell injury, despite a limited impact on neointimal hyperplasia and luminal stenosis. This observation identifies novel molecular targets of paricalcitol in the vascular system, whose differential expression cannot be justified as a consequence of improved tissue injury.

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Section: Discussionmentioning

confidence: 99%

Paricalcitol Has a Potent Anti-Inflammatory Effect in Rat Endothelial Denudation-Induced Intimal Hyperplasia

Baeza,

Pintor-Chocano,

Carrasco

et al. 2024

IJMS

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“…The COVID-19 pandemic also caused a lot of misinformation concerning vitamin D, especially on the internet ( 29 ), which can result in cases of supplement induced vitamin D toxicity ( 30 , 31 ). In our study, two cases (in a sample of 244 cases) were detected with 25(OH)D >250 nmol/L.…”

Section: Discussionmentioning

confidence: 99%

Vitamin D Supplementation During COVID-19 Lockdown and After 20 Months: Follow-Up Study on Slovenian Women Aged Between 44 and 66

VIČIČ,

PANDEL MIKUŠ

2023

Slovenian Journal of Public Health

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Introduction The main objective was to assess the impact of the COVID-19 pandemic on vitamin D supplementation habits and their changes in the follow-up, 20 months after the study in Slovenian premenopausal and postmenopausal women. Methods A cross-sectional study was conducted between March and May 2021. 176 healthy women aged 44 to 65 from the Central Slovenian region were included in the final analysis. Vitamin D status was determined by measuring 25(OH)D concentration. After 20 months an online follow-up questionnaire was sent out, to which 123 participants responded with complete data. Results Between March and May 2021, 61% of the participants were supplementing vitamin D. 55% of the supplementers and 88% of the non-supplementers had insufficient levels (total 25(OH)D <75 nmol/L). After 20 months in the follow-up, it was found that 62% of participants were taking vitamin D supplements, but only 70% of those who had initially reported taking supplements were still doing so. In the follow-up 61% of participants stated that they started or increased vitamin D intake due to COVID-19. Conclusions Vitamin D supplementation increased 7-fold compared to pre-pandemic levels and remained at a high level after 20 months. However, a significant number of participants discontinued supplementation, and only one-fifth were taking vitamin D throughout the entire year. Supplementation is effective for vitamin D deficiency prevention only at the individual level, however due to low compliance it should not be the only strategy for preventing vitamin D deficiency in the population.

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“…A betegség pontos prevalenciája ismeretlen, általánosságként azonban elmondható, hogy az utóbbi évtizedben a D 3 -vitamint tartalmazó készítmények népszerűsége növekedett a felnőtt populációban, az intoxikációk számában is emelkedés várható a szerzők véleménye sze-rint. A tudományos sajtóban évi néhány, hospitalizációra szoruló esetről számolnak be világszerte [14][15][16].…”

Section: Esetismertetésunclassified

A vesekárosodás ritka oka: D3-vitamin-intoxikáció

Hutkai,

Bodor

2023

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A D3-vitamin-kezelés jótékony hatásai ismertek, mellékhatásai dokumentáltak. Az esetbemutatás kapcsán kívánjuk ismertetni a túlzó D-vitamin-pótlás veszélyeit, illetve a hétköznapi orvosi gyakorlatban tapasztalt hiányosságokra szeretnénk irányítani a figyelmet. Tárgyaljuk a D-vitamin-intoxikáció kórisméjének megalkotásához, az elkülönítő kórisméhez szükséges vizsgálatokat, valamint bemutatjuk a lehetséges kezelési stratégiákat. Az 57 éves nőbeteget néhány napja tartó hányinger, hányás, hasmenés, általános gyengeség tünetei miatt kezelte más intézmény 2020 novemberében. Felvételekor a laborvizsgálatokban új keletű vesekárosodás (eGFR 38 ml/p/1,73 m2) igazolódott, a kalcium-anyagcsere ellenőrzése nem történt meg. Nefrológiai konzíliuma akut tubuluskárosodást feltételezett, ezért vesebiopszia elvégzésére került sor, immunszerológiai vizsgálatok és a szérumfehérje elektroforézis-vizsgálata történt. A konzervatív kezelés ellenére a vesefunkció romlott (eGFR 32 ml/p/1,73 m2). Folyamatban lévő vizsgálati eredményekkel érkezett a beteg klinikánkra 2020 decemberében. Az érkezésekor végzett laborvizsgálatokban súlyos hypercalcaemia igazolódott (tCa 3,22 mmol/l, iCa 1,74 mmol/l), vesefunkciója stagnált (eGFR 33 ml/p/1,73 m2). Intakt parathormonszintje a normáltartomány alatt volt (0,54 pmol/l), 25-OH-D-vitamin-szintje extrém magasnak bizonyult (1106,2 nmol/l). A beteg ekkor elismerte, hogy 2020. októberben „megadózisú” parenteralis D3-vitamin-kúrában részesült egy harmadik intézményben; a kezelés pontos dózisát nem tudta megnevezni, a kezelést alkalmazó intézmény kilétét nem kívánta felfedni. D3-vitamin-intoxikációt véleményeztünk. Iv. parenteralisan krisztalloid, furoszemid, kalcitonin adásában részesült, melyek hatására szérumkalciumszintje normalizálódott (2,52 mmol/l), vesefunkciói javultak (eGFR 54 ml/p/1,73 m2). Szérum-tCa- és D-vitamin-szintje 2021. februárra normalizálódott, vesefunkciói javultak (tCa 2,54 mmol/l, 25-OH-D-vitamin 125,0 ng/ml, eGFR 72 ml/p/1,73 m2). A vesebiopszia akut tubularis necrosis jelenlétét igazolta. Granulomás gyulladás, myeloma multiplex nem igazolódott. A D-vitamin-intoxikáció tünetei nem specifikusak és változatosak, differenciáldiagnosztikai kihívást jelent egy-egy eset. Orv Hetil. 2023; 164(47): 1871–1876.

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Vitamin D intoxication and severe hypercalcaemia complicating nutritional supplements misuse

Cited by 10 publications

References 7 publications

Paricalcitol Has a Potent Anti-Inflammatory Effect in Rat Endothelial Denudation-Induced Intimal Hyperplasia

Paricalcitol Has a Potent Anti-Inflammatory Effect in Rat Endothelial Denudation-Induced Intimal Hyperplasia

Vitamin D Supplementation During COVID-19 Lockdown and After 20 Months: Follow-Up Study on Slovenian Women Aged Between 44 and 66

A vesekárosodás ritka oka: D3-vitamin-intoxikáció

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