Hypercalcemia Due to Vitamin D Toxicity

Confusion, apathy, recurrent vomiting, abdominal pain, polyuria, polydipsia, and dehydration are the most often noted clinical symptoms of vitamin D toxicity (VDT; also called vitamin D intoxication or hypervitaminosis D). VDT and its clinical manifestation, severe hypercalcemia, are related to excessive long-term intake of vitamin D, malfunctions of the vitamin D metabolic pathway, or the existence of coincident disease that produces the active vitamin D metabolite locally. Although VDT is rare, the health effects can be serious if it is not promptly identified. Many forms of exogenous (iatrogenic) and endogenous VDT exist. Exogenous VDT is usually caused by the inadvertent or improper intake of extremely high doses of pharmacological preparations of vitamin D and is associated with hypercalcemia. Serum 25-hydroxyvitamin D [25(OH)D] concentrations higher than 150 ng/ml (375 nmol/l) are the hallmark of VDT due to vitamin D overdosing. Endogenous VDT may develop from excessive production of an active vitamin D metabolite – 1,25(OH)2D in granulomatous disorders and in some lymphomas or from the reduced degradation of that metabolite in idiopathic infantile hypercalcemia. Endogenous VDT may also develop from an excessive production of 25(OH)D and 1,25(OH)2D in congenital disorders, such as Williams–Beuren syndrome. Laboratory testing during routine clinical examinations may reveal asymptomatic hypercalcemia caused by the intake of vitamin D even in doses recommended for the general population and considered safe. That phenomenon, called hypersensitivity to vitamin D, reflects dysregulated vitamin D metabolism. Researchers have proposed many processes to explain VDT. Those processes include elevated activity of 1α-hydroxylase or inhibited activity of 24-hydroxylase, both leading to increased concentration of 1,25(OH)D; increased number of vitamin D receptors; and saturation of the capacity of vitamin D binding protein. 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 then recommended for age and body weight or even higher than the established upper limit intake values. Consequently, the incidence of hypercalcemia due to hypervitaminosis D might increase.

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“…Treatment of VDT consists of first- and the second-line treatment strategies ( 3 , 25 , 27 ). First-line treatment includes the following:…”

Section: Treatment Of Acute Vdtmentioning

confidence: 99%

Vitamin D Toxicity–A Clinical Perspective

Marcinowska-Suchowierska

et al. 2018

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“…Ниркові симптоми включають гіперкальціурію як першу ознаку, поліурію, полідипсію, дегідратацію, нефрокальциноз та ниркову недостатність. Інші симптоми токсичності вітаміну D, спричинені гіперкальціємією, включають стрічкову кератопатію, втрату слуху та періартикулярний кальциноз [33][34][35].…”

Section: синдром токсичности витамина D: взгляд токсикологаunclassified

“…Renal symptoms include hypercalciuria as the first sign, polyuria, polydipsia, dehydration, nephrocalcinosis, and renal failure. Other symptoms of vitamin D toxicity caused by hypercalcemia include tape keratopathy, hearing loss, and periarticular calcification [33][34][35].…”

Section: синдром токсичности витамина D: взгляд токсикологаmentioning

confidence: 99%

Vitamin D toxicity syndrome: a toxicologist's view

Padalka

Kurdil

Zinovieva

et al. 2021

OHNPU

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Vitamin D-related health problems remain a global health problem. The growing number of prescriptions of vitamin D by doctors during the COVID-19 pandemic and the increase in self-intake of vitamin D by the population carries the risk of exogenous hypervitaminosis D, or a syndrome known as vitamin D toxicity. Aim: to summarize the results of scientific research on the vitamin D toxicity, and some aspects related to its overdose. Material and Methods: used methods of content analysis, system and comparative analysis; materials of scientific reviews and separate researches devoted to biochemistry and toxicology of vitamin D (Elsevier, PubMed, ToxNet) with depth of search to 20 years. Results and Discussion. Due to the well-known health risks of vitamin D deficiency, it has become a popular dietary supplement, as evidenced by the progressive growth of both thematic scientific publications (PubMed) and its consumption in many countries around the world. The use of pharmaceuticals and dietary supplements is the most common cause of overdose. A review of cases of vitamin D toxicity caused by errors in prescribing or administering the required dose has shown that they may occasionally be accompanied by the development of intoxication. There are many forms of exogenous and endogenous vitamin D toxicity syndrome. Vitamin D toxicity syndrome includes the following symptoms: loss of consciousness, apathy, intermittent vomiting, abdominal pain, polyuria, polydipsia, dehydration, and hypercalcemia, which, although uncommon, can be life-threatening if not detected timely, and is an important symptom in the differential diagnosis in patients with hypercalcemia. Despite differing opinions on the target concentration of 25(OH)D or recommended doses of vitamin D for the general population, it was determined that the concentration of 25 (OH) D> 150 ng/ml is a significant risk of developing vitamin D toxicity syndrome, and vitamin D deficiency treatment regimens at high doses require regular monitoring. Conclusions: There is a growing public awareness of the health benefits of vitamin D; however, the increase in its consumption carries, inter alia, the risk of a specific syndrome ‒ the vitamin D toxicity. Family physicians should be informed about the danger of exceeding the recommended (age and body weight) doses, and carry out explanatory work with the public to raise awareness of adverse effects vitamin D overdose. Key Words: vitamin D, toxicity.

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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 10 publications

References 216 publications

Vitamin D Toxicity–A Clinical Perspective

Vitamin D Toxicity–A Clinical Perspective

Vitamin D toxicity syndrome: a toxicologist's view

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

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