Vitamin D toxicity: A prospective study from a tertiary care centre in Kashmir Valley

Abstract

Background: Vitamin D toxicity (VDT), a “not uncommon” cause of hypercalcemia, can be life-threatening and cause substantial morbidity, if not treated promptly. Aims: To describe presentation, management, and outcome in 32 patients with VDT diagnosed over 3 years. Materials and Methods: Patients presenting with VDT at a tertiary care centre in Srinagar Kashmir India were included. Evaluation included detailed history and biochemical tests including serum calcium, phosphate, creatinine, intact parathyroid hormone (iPTH), 25-hydroxy Vitamin D (25-OHD), and 24-hour urinary calcium. Results: The clinical manifestations of the 32 patients (median age 65; range 3–77 years) included gastrointestinal symptoms (constipation and vomiting), polyuria/polydipsia, altered sensorium, pancreatitis, acute kidney injury, and nephrocalcinosis. The median total serum calcium level was 13.95 (range 11.10-17.20) mg/dl and median 25-OHD level was 306 (range 105–2800) ng/ml. All patients had suppressed or low normal iPTH and hypercalciuria and 78% had azotemia. All patients had received multiple intramuscular injections of vitamin D 3 . The median cumulative dose was 4,200,000 (range, 1,800,000-30,000,000) IU. The median time to resolution of hypercalcemia was 7 months (range 4–18 months). Conclusion: We conclude that VDT is an increasingly common cause of symptomatic hypercalcemia. VDT needs prolonged follow up as it takes months to abate its toxicity. Enhancing awareness among general practitioners regarding the toxicity resulting from high doses of vitamin D is the key to prevent VDT. We suggest that VDT be considered in patients, especially the elderly, presenting with polyuria, polydispsia, vomiting, azotemia, or encephalopathy.

Treatment with Vitamin D3 in Vitamin D Deficient Adolescents: A Pilot Study

“…Treatment with 2000 to 5000 IU of vitamin D3 daily has not been associated with vitamin D toxicity, 31,32 whilst super high doses for prolonged periods have been reported to cause hypercalcemia and nephrolithiasis. [33][34][35] In our population of healthy vitamin D deficient adolescents, we empirically treated the vitamin D deficient subjects with 2000 IU of vitamin D3 daily for 3 months. Following treatment with vitamin D3, there was a 56.02% increase of the mean vitamin D levels from the mean pretreatment values and the levels normalized in 80.39% of the subjects.…”

Efficacy of oral Vitamin D supplementation in reducing body mass index and lipid profile in adolescents and young adults in Colombia

“…In adolescence, plasma levels decrease and needs increase; however, the recommendation is the same as for adults. [ 17 ]…”

“…[ 18 ] On the other hand, the doses that have been documented to lead to toxicity are above 40,000 IU to 50,000 IU per day. [ 16 , 17 ] This is considered as potentially severe condition whose symptoms are associated to secondary hypercalcemia and are mainly of a gastrointestinal nature (anorexia, nausea, vomit, constipation, diarrhea, abdominal pain) and polydipsia, polyuria, muscular weakness and fatigue, among the most relevant. [ 19 ]…”

Forget the phosphorus: A case of hypervitaminosis D-induced symptomatic hypercalcemia

“…Vitamin D3 supplementation is commonly used for musculoskeletal health, and there has been an increase in use as studies report health benefits including improvement in symptoms of depression and blood pressure, and decreased respiratory infections and mortality [ 1 , 2 ]. Although hypervitaminosis D is uncommon, multiple studies have demonstrated toxicity from high dose supplementation [ 3 , 4 , 5 , 6 , 7 , 8 ]. Hypervitaminosis D results in hypercalcemia and classically presents with hyperphosphatemia [ 9 ].…”