Hypercalcemia Due to Vitamin D Toxicity

Cusano, Natalie E.; Thys-Jacobs, Susan; Bilezikian, John P.

doi:10.1016/b978-0-12-809963-6.00082-1

Cited by 7 publications

(6 citation statements)

References 215 publications

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“…A definite amount of vitamin D ingestion to cause toxicity has not been elucidated. Although maximum tolerable ingested dose is various in different age groups, maximum tolerable and safe dose of vitamin D is 1000 IU/day in infants younger than 6 months, 1500 IU/ day in children older than 6 months, and 10000 IU/day in adults [27,28,[30][31][32][33]. Vitamin D concentration is measured by 25-hydroxy vitamin D level because it has longer half-life compared to 1,25 OH vitamin D [27,34].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with vitamin D toxicity may be asymptomatic or have signs or symptoms including nausea, vomiting, dehydration, abdominal pain, loss of appetite, irritation, headache, constipation, polyuria, polydipsia, fever, and growth retardation. In fact, most of the patients' symptoms are compatible with high serum calcium level [32,36]. Differences between symptoms and laboratory parameters in patients may be related to gastrointestinal absorption, vitamin D binding protein, vitamin D receptor (VDR), vitamin D storage, and diet [21,32,36].…”

Section: Discussionmentioning

confidence: 99%

“…In fact, most of the patients' symptoms are compatible with high serum calcium level [32,36]. Differences between symptoms and laboratory parameters in patients may be related to gastrointestinal absorption, vitamin D binding protein, vitamin D receptor (VDR), vitamin D storage, and diet [21,32,36]. All of our patients were asymptomatic and it might be due to the maximum tolerable intake dose differences in various groups and high prevalence of vit D deficiency among Iranian children [14,32].…”

Section: Discussionmentioning

confidence: 99%

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Vitamin D toxicity in a pediatric toxicological referral center; a cross-sectional study from Iran

et al. 2020

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Background Vitamin D is an essential element for body health with its supplements generally administered to prevent vitamin D deficiency. Since these supplements are available in domestic settings, vitamin D toxicity may happen in children. Methods All children younger than 12 years who presented to the pediatric emergency department of Loghman Hakim Hospital, Tehran, Iran with history of ingestion of more than 1500 IU/day of vitamin D supplements were enrolled. Patients’ demographic data, on-presentation signs and symptoms, laboratory findings, treatments given, and outcome were evaluated. Result Fifteen patients presented during the study period. Their mean age was 46.53 ± 10.14 months and 12 (80%) were girls. All of them had unintentionally ingested vitamin D. Mean ingested dose was 406700.7 ± 227400.1 IU. In eight patients (53.3%), 25 hydroxy vitamin D level was more than 100 ng/mL. One patient experienced hypercalcemia while all of them were asymptomatic and discharged without complications. There was no significant difference between patients with and without high levels of 25 OH vitamin D regarding lab tests, toxicity course, and outcome. Conclusions It seems that acute vitamin D toxicity is a benign condition in our pediatric population which may be due to high prevalence of vitamin D deficiency in Iran.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Vitamin D toxicity in a pediatric toxicological referral center; a cross-sectional study from Iran

et al. 2020

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“…e Endocrine Society states that vitamin D toxicity is defined as 25(OH)D concentrations exceeding 375 nmol/L [19], with levels above this toxic threshold associated with the onset of hypercalcemia [19][20][21]. Signs and symptoms of vitamin D intoxication are directly related to the effects of hypercalcemia [17,20,22], including decreased oral intake, nausea, vomiting, constipation, weakness, lethargy, and generalized malaise [17,20,21]. Hypercalcemia and vitamin D toxicity can lead to serious complications including renal failure, hypertension, and nephrocalcinosis [17,23,24].…”

Section: Discussionmentioning

confidence: 99%

Vitamin D Intoxication and Nephrocalcinosis in a Young Breastfed Infant

Al-Kandari

Sadeq

Alfattal

et al. 2021

Case Reports in Endocrinology

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Numerous studies were performed assessing the benefits and side effects of vitamin D. Vitamin D helps in regulating the calcium and phosphate metabolism leading to a healthy mineral and bone development. Vitamin D intoxication is an uncommon event that leads to hypercalcemia which can be associated with both immediate and late morbidities that can cause severe renal complications. Here, we present a case of a 4-month-old girl with a history of decreased feed and activity due hypercalcemia and high vitamin D level, which led to nephrocalcinosis. The patient received IV fluids, IV diuretics, methylprednisolone, and bisphosphonate in order to normalize the calcium level in blood. With clear verbal and written instructions for the dosage and administration of vitamin D supplements, as well as clear warnings of the potential risks of overdose, vitamin D intoxication could be an easily avoidable condition.

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“…The initial hypercalciuria may be ameliorated as renal failure progresses because of reduced calcium clearance. When reduced renal blood flow occurs, less calcium is presented to the renal glomerulus and hypercalcaemia can rapidly progress (Cusano et al., ).…”

Section: Introductionmentioning

confidence: 99%

Update of the tolerable upper intake level for vitamin D for infants

Products¹,

Turck²,

Bresson³

et al. 2018

EFS2

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Following a request from the European Commission, the Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to revise the tolerable upper intake level (UL) for vitamin D for infants (≤ 1 year) set in 2012. From its literature review, the Panel concluded that the available evidence on daily vitamin D intake and the risk of adverse health outcomes (hypercalciuria, hypercalcaemia, nephrocalcinosis and abnormal growth patterns) cannot be used alone for deriving the UL for infants. The Panel conducted a meta‐regression analysis of collected data, to derive a dose–response relationship between daily supplemental intake of vitamin D and mean achieved serum 25(OH)D concentrations. Considering that a serum 25(OH)D concentration of 200 nmol/L or below is unlikely to pose a risk of adverse health outcomes in infants, the Panel estimated the percentage of infants reaching a concentration above this value at different intakes of vitamin D. Based on the overall evidence, the Panel kept the UL of 25 μg/day for infants aged up to 6 months and set a UL of 35 μg/day for infants 6–12 months. The Panel was also asked to advise on the safety of the consumption of infant formulae with an increased maximum vitamin D content of 3 μg/100 kcal (Commission Delegated Regulation (EU) 2016/127 repealing Directive 2006/141/EC in 2020). For infants aged up to 4 months, the intake assessment showed that the use of infant formulae containing vitamin D at 3 μg/100 kcal may lead some infants to receive an intake above the UL of 25 μg/day from formulae alone without considering vitamin D supplemental intake. For infants aged 4–12 months, the 95th percentile of vitamin D intake (high consumers) estimated from formulae and foods fortified or not with vitamin D does not exceed the ULs, without considering vitamin D supplemental intake.

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Hypercalcemia Due to Vitamin D Toxicity

Cited by 7 publications

References 215 publications

Vitamin D toxicity in a pediatric toxicological referral center; a cross-sectional study from Iran

Vitamin D toxicity in a pediatric toxicological referral center; a cross-sectional study from Iran

Vitamin D Intoxication and Nephrocalcinosis in a Young Breastfed Infant

Update of the tolerable upper intake level for vitamin D for infants

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