Vitamin D Toxicity: A Clinical Perspective

Marcinowska-Suchowierska, Ewa; Kupisz-Urbańska, Małgorzata; Łukaszkiewicz, Jacek; Płudowski, Paweł; Jones, Glenville

doi:10.37247/paendo.1.2020.8

Cited by 10 publications

(12 citation statements)

References 24 publications

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“…As a result of excessive intake of vitamin D, serum levels of vitamin D metabolites (25(OH)D; 24,25(OH)2D; 25,26 (OH)2D; and 25(OH)D‐26,23‐lactone) increase and exceed vitamin D binding protein binding capacity, causing the increase of free active metabolite 1,25(OH) 2 D. This vitamin D metabolite reaches the vitamin D receptor (VDR) in the nucleus of cells and increases calcium absorption and bone mobilisation by causing exaggerated gene expression. As a result, it causes hypercalcemia and hyperphosphatemia, resulting in iPTH suppression 26 . While the most common cause of vitamin D‐associated hypercalcemia is iatrogenic supplementation, production of ectopic 1,25‐dihydroxyvitamin D (sarcoidosis, tuberculosis, fungal diseases, granulomatous diseases such as leprosy, and lymphoma) can cause inactivating mutations of the CYP24A1 gene 27 .…”

Section: Discussionmentioning

confidence: 99%

“…In addition to hypercalcemia, vitamin D intoxication can cause several symptoms such as depression, stupor, and coma psychiatrically; short QT, bradyarrhythmia, and hypertension in the cardiovascular system; nausea, vomiting, constipation, peptic ulcer, and pancreatitis in the gastrointestinal tract; and hypercalciuria, nephrocalcinosis, and renal failure in the kidneys 28 . In addition to 25(OH)D level >150 ng/mL biochemically, vitamin D intoxication can be symptomatic; hypercalcemia, hypercalciuria, and parathyroid hormone suppression can be seen 26 . Some studies have observed that in cases with vitamin D intoxication and hypervitaminosis, vitamin D level and serum calcium levels were not associated, and most of the cases were normocalcemic 29,30 .…”

Section: Discussionmentioning

confidence: 99%

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Risk of hypercalcemia in patients with very high serum 25‐OH vitamin D levels

et al. 2021

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Objective: We aimed to evaluate the risk of hypercalcemia in patients with very high levels of 25-hydroxy vitamin D (25(OH)D). Methods:The distribution of patients who were screened for 25(OH)D in our hospital between January 2014 and December 2018 was evaluated and patients with serum concentrations of 25(OH)D >88 ng/mL were selected. Then, biochemical parameters of the cases with 25(OH)D >88 ng/mL were compared according to calcium status, vitamin D level (group 1, 88-100 ng/mL; group 2, 100-150 ng/mL, and group 3, >150 ng/mL), and gender.Results: A total of 282 932 patients who underwent 25(OH)D tests in our hospital were evaluated. A total of 1311 (0.5%) patients had very high 25(OH)D levels (>88 ng/mL). Four hundred and ninety-five patients who met our inclusion criteria and had complete data participated in the study. The median age was 58 years (interquartile range [IQR] = 41-71 years) and the median level of 25(OH)D was 104.6 mg/ mL (IQR = 94.9-124.9 ng/mL). Most of the subjects (83.7%) with very high 25(OH) D levels were normocalcemic. A weak inverse correlation was observed between 25(OH)D level and intact parathyroid hormone (iPTH) level (r = −0.118, P = .01), but no correlation between 25(OH)D and calcium levels was observed. Alkaline phosphatase (ALP) levels were significantly higher in males (P = .032), and age and iPTH levels were higher in females (P < .001 and P = .004). ALP, phosphorus levels, and iPTH suppression rates were higher in hypercalcemic patients (P < .001, P < .001, and P < .001, respectively), while the iPTH level was significantly lower in hypercalcemic patients (P < .001) than in normocalcemic patients. Amongst the three groups with different 25(OH)D levels, no difference was found in levels of iPTH, calcium, phosphorus, ALP, or age. Conclusion:Most patients with very high vitamin D levels were normocalcemic, but severe hypercalcemia was also observed. Vitamin D replacement therapy and followup should be performed according to clinical guideline recommendations. How to cite this article: Batman A, Saygili ES, Yildiz D, et al. Risk of hypercalcemia in patients with very high serum 25-OH vitamin D levels.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk of hypercalcemia in patients with very high serum 25‐OH vitamin D levels

et al. 2021

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“…Corticosteroid therapy (prednisone or prednisolone) has also been the cornerstone of management of 1,25-dihydroxyvitamin mediated hypercalcemia. It lowers the calcium level by reducing intestinal calcium absorption by decreasing transcellular active transport processes, increasing urinary excretion of calcium and altering the hepatic vitamin D metabolism to favor synthesis of inactive metabolites [ 24 ]. Second line therapy of VDT includes phenobarbital, ketoconazole, or aminoquinolones [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Vitamin D Toxicity Managed with Peritoneal Dialysis

Feghali

Papamarkakis

Clark

et al. 2021

Case Reports in Endocrinology

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Vitamin D deficiency is a global health issue that afflicts more than one billion children and adults worldwide. Vitamin D supplementation has increased over the years, whether through medical prescriptions, over-the-counter, or online purchasing. This is driven by a more recognized association between vitamin D sufficiency status and lower risk of cancer. In addition, more recently, it is used as a potential prophylactic and treatment for COVID-19 infection. This can lead to toxicity from overingestion. While rare, it has been reported in the literature. In this case report, we present a 75-year-old man with severe hypercalcemia secondary to vitamin D toxicity managed with peritoneal dialysis. He presented with biochemical evidence of hypercalcemia, acute kidney injury, and pancreatitis. Workup for his hypercalcemia led to the diagnosis of vitamin D toxicity as shown by a level greater than 200 ng/dL (Ref: 20–50 ng/mL) was confirmed by liquid chromatography-mass spectroscopy. Cornerstone medical management of hypercalcemia was provided which included aggressive intravenous fluid hydration, intravenous diuretics, calcitonin, bisphosphonate, and corticosteroid therapy. At every interruption of therapy, calcium levels trended upward. A thorough literature review yielded the finding of a sole case report from 1966 presented at the Third International Congress of Nephrology, in which peritoneal dialysis was used in the management of vitamin D toxicity and hypercalcemia. This modality is established to cause vitamin D deficiency. In collaboration with the nephrology team, 10 sessions of peritoneal dialysis were undertaken with resolution of hypercalcemia and downtrend in 25-hydroxyvitamin D levels as measured by dilution.

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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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Vitamin D Toxicity: A Clinical Perspective

Cited by 10 publications

References 24 publications

Risk of hypercalcemia in patients with very high serum 25‐OH vitamin D levels

Risk of hypercalcemia in patients with very high serum 25‐OH vitamin D levels

Vitamin D Toxicity Managed with Peritoneal Dialysis

Vitamin D Intoxication and Nephrocalcinosis in a Young Breastfed Infant

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