Vitamin D Toxicity in Adults: A Case Series from an Area with Endemic Hypovitaminosis D

Abstract

Vitamin D deficiency state is endemic to the Kashmir valley of the Indian subcontinent. Physicians often treat patients with high doses of vitamin D for various ailments and on occasion the prescribed doses far exceed the requirements of the patients. Ten cases of hypercalcemia due to vitamin D intoxication are presented with features of vomiting, polyuria, polydipsia, encephalopathy and renal dysfunction. All the patients had demonstrable hypercalcemia and vitamin D levels were high in nine of the 10 cases. The patients had received high doses of vitamin D and no other cause of hypercalcemia was identified. Treatment of hypercalcemia resulted in clinical recovery in nine cases. We conclude that hypervitaminosis D must be considered in the differential diagnosis of patients with hypercalcemia in endemically vitamin D deficient areas. A careful history and appropriate biochemical investigation will unravel the diagnosis in most of the cases.

Increased biological response to 1,25(OH)2D3in genetic hypercalciuric stone-forming rats

“…Hypercalcemia and hypercalciuria induced with oral dihydrotachysterol, a synthetic vitamin D analog, in rats (92) and hypervitaminosis D in humans (50,53) are associated with polyuria. Activation of the Ca-sensing receptor by the hyper- calciuria may decrease vasopressin-induced water reabsorption (82) in the cortical collecting duct, although this purported mechanism is controversial (9).…”

Intoxicação Por Calcitriol Após Tratamento De Hipoparatireoidismo Transitório

“…Além disso, apresenta outras funções biológicas fundamentais na diferenciação celular, inibição do crescimento celular e modulação imune 2,3 .…”

“…1 A toxicidade da vitamina D, também chamada hipervitaminose D, é extremamente rara, potencialmente grave, e ocorre em doses mais elevadas. 1,2 As características clínicas da hipervitaminose D são decorrentes, principalmente, da hipercalcemia. 1,2 Diante de um quadro de vômitos persistentes e hipercalcemia, na presença de hormônio da paratireódide normal, o diagnóstico de intoxicação por vitamina D deve ser suspeitado e, a normalização de seus níveis alivia os sintomas e pode prevenir lesão renal aguda.…”

“…1,2 As características clínicas da hipervitaminose D são decorrentes, principalmente, da hipercalcemia. 1,2 Diante de um quadro de vômitos persistentes e hipercalcemia, na presença de hormônio da paratireódide normal, o diagnóstico de intoxicação por vitamina D deve ser suspeitado e, a normalização de seus níveis alivia os sintomas e pode prevenir lesão renal aguda. 3 Nesse artigo, será relatado um caso de intoxicação por calcitriol.…”

Are we too reluctant about irrational nutraceutical combinations?

“…Case series by Koul PA et al found nine of ten cases of hypercalcaemia are due to Vitamin D toxicity. [11][12][13] In vitro pharmaceutical interactions are well known. In a nutraceutical combination, extent to which iron and calcium absorb and be beneficial to the patient is questionable.…”