Vitamin D toxicity: Rare but real case
In this video, Dr. Seheult of MedCram discusses a case report of an individual who had severe vitamin D toxicity. This video’s discussion of this case report is meant to be a cautionary tale for individuals who are taking supplements, especially fat soluble vitamin supplements, and the importance of getting levels checked regularly.
Case report vitamin D toxicity
In this case report, it involves a middle aged man with multiple medical problems including a past medical history of tuberculosis in the spine, a left ear schwannoma, history of hydrocephalus with a ventriculoperitoneal (VP) shunt placement, bacterial meningitis, and chronic sinusitis. This individual was taking multiple high dose supplements including vitamin D 150,000 IU (normal recommended daily supplementation is 400 IU) and vitamin K 100 mcg a day (this is a normal supplementation dose) and calcium supplements of 1000 mg a day. Vitamin D as well as K are both fat soluble vitamins.
After taking these supplement amounts for about 1 month, he began to develop symptoms of nausea, vomiting, abdominal pain, leg cramps and ear ringing. When he got these symptoms, he discontinued taking all of his supplements. However, 3 months later he was still having symptoms and at this time decided to seek medical care. He presented 4 months to the hospital after he initially started taking meds. He had lost approximately 28 lbs at this time. The hospital ran bloodwork on him and found he had severely elevated calcium levels of 15.6 mg/dL (upper limit of normal around 10.4 mg/dL) along with acute renal failure (creatinine 1.9 mg/dL with normal upper limit of around 1.4 mg/dL) and a vitamin D level of greater than 400 nmol/L (normally should be around 50 nmol/L). This patient was essentially experiencing symptoms of severe hypercalcemia with vitamin D toxicity.
Vitamin D metabolism
Vitamin D is normally converted from the inactive form (25 OH vit D) to the active form (1,25 OH vit D) via the kidney. Certain diseases however can allow this regulatory process to bypass the kidney and make active vitamin D. In this individual’s case he had such a disease, the tuberculosis of his spine, that can cause granulomas and will directly convert inactive vitamin D to the active vitamin D. Not unsurprisingly, these individuals are at increased risk of getting elevated vitamin D levels and lead to toxicity. Taking high supplementation of vitamin D in individuals with granulomatous disease can put them at risk for vitamin D toxicity and hypercalcemia.
Vitamin D toxicity
Treatment of hypercalcemia first involves fluid resuscitation. Medcram.com has educational videos on this. In this individual, his calcium levels were decreased during his hospitalization and his renal function also improved over time. For his 6 month follow up at an endocrine clinic, his repeat vitamin D levels were still greater than 400 nmol/L. This is a great example of how fat soluble vitamins can stay in your system for long periods of time and why it is important to check levels of these vitamins (A, D, E, K) regularly if you are taking supplementation to avoid toxicity. Symptoms of vitamin D toxicity can include confusion, depression, abdominal pain, vomiting, constipation, hypertension, and renal failure to name a few.
Vitamin D supplementation
Vitamin D supplementation is normally a safe thing to do but it must be done in a safe manner. Remember, although over the counter supplements do not need prescriptions, they are not harmless and can interact with other medications. It can be easy to “overdose” on these if you are not careful and monitoring bloodwork. Always be sure to provide your physician with a list of your supplements. MedCram has a video on vitamin D that is a great reference about the benefits of vitamin D.
LINKS / REFERENCES:
Vitamin D intoxication and severe hypercalcemia complicating nutritional supplements misuse (BMJ) | https://casereports.bmj.com/content/1…
Granulomatous Disorders and Vitamin D Hypersensitivity (GHNRI) | https://www.grassrootshealth.net/blog…
Vitamin D and COVID 19: The Evidence for Prevention and Treatment of Coronavirus (MedCram) | https://youtu.be/ha2mLz-Xdpg
ECG / EKG Interpretation Explained Clearly (MedCram) | https://www.medcram.com/courses/ekg-e…
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