{"id":1248,"date":"2022-07-09T12:12:00","date_gmt":"2022-07-09T19:12:00","guid":{"rendered":"https:\/\/blog.medcram.com\/?p=1248"},"modified":"2022-07-12T12:32:52","modified_gmt":"2022-07-12T19:32:52","slug":"case-report-vitamin-d-toxicity","status":"publish","type":"post","link":"https:\/\/blog.medcram.com\/endocrinology\/case-report-vitamin-d-toxicity\/","title":{"rendered":"Vitamin D toxicity: Rare but real case"},"content":{"rendered":"<p style=\"text-align: center;\"><iframe loading=\"lazy\" title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/mGDvmVhrVQw\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><span style=\"font-weight: 400;\">In this video, Dr. Seheult of MedCram discusses a case report of an individual who had severe vitamin D toxicity. This video\u2019s 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.\u00a0<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Case report vitamin D toxicity<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">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.\u00a0<\/span><\/p>\n<h2>Clinical Presentation<\/h2>\n<p><span style=\"font-weight: 400;\">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\u00a0 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.<\/span><\/p>\n<h2>Vitamin D metabolism<\/h2>\n<p><span style=\"font-weight: 400;\">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\u2019s 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.\u00a0<\/span><\/p>\n<h2>Vitamin D toxicity<\/h2>\n<p><span style=\"font-weight: 400;\">Treatment of hypercalcemia first involves fluid resuscitation.\u00a0 <\/span><a href=\"https:\/\/www.medcram.com\/\"><span style=\"font-weight: 400;\">Medcram.com<\/span><\/a><span style=\"font-weight: 400;\"> has educational videos on this.\u00a0 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.\u00a0 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.\u00a0<\/span><\/p>\n<h2>Vitamin D supplementation<\/h2>\n<p><span style=\"font-weight: 400;\">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 \u201coverdose\u201d on these if you are not careful and monitoring bloodwork. Always be sure to provide your physician with a list of your supplements.\u00a0 MedCram has a <\/span><a href=\"https:\/\/www.youtube.com\/watch?v=ha2mLz-Xdpg&amp;t=2s\"><span style=\"font-weight: 400;\">video on vitamin D<\/span><\/a><span style=\"font-weight: 400;\"> that is a great reference about the benefits of vitamin D.\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><strong>LINKS \/ REFERENCES:<\/strong><\/p>\n<p><span style=\"font-weight: 400;\">Vitamin D intoxication and severe hypercalcemia complicating nutritional supplements misuse (BMJ) |<\/span><a href=\"https:\/\/www.youtube.com\/redirect?event=video_description&amp;redir_token=QUFFLUhqblNYSXZMWkc2c2tST1hHUklxQnJlUjM4WDQyd3xBQ3Jtc0tsbzBSTHVDa2tTZnN0bVA1cFhSbmxNX3BOZURwd2picU9INjBBbWZYNTYwQ0E3Qll6bzBSQTh4VEdLbzEwNVFST1VZLWJvcnZFODliMXkzTko2bWVTWnN4ZkFYemo5dFNxUGhPVXZ0bjR2SmdyVXlYSQ&amp;q=https%3A%2F%2Fcasereports.bmj.com%2Fcontent%2F15%2F7%2Fe250553%23t1&amp;v=mGDvmVhrVQw\"><span style=\"font-weight: 400;\"> https:\/\/casereports.bmj.com\/content\/1&#8230;<\/span><\/a><\/p>\n<p><span style=\"font-weight: 400;\">Granulomatous Disorders and Vitamin D Hypersensitivity (GHNRI) |<\/span><a href=\"https:\/\/www.youtube.com\/redirect?event=video_description&amp;redir_token=QUFFLUhqbUFGS3ZWUnFXWFlfemNYcEN4TlN3bHQ1UzhCQXxBQ3Jtc0tueVdOOThVUncyV0VaTTN2b1B0SDBIVVljU1J6Xy03WWdNV2pqWFpqaXF6ajVpUVhBdFp6RHdxSkd6SjBVOFY1TlNUUGdwR29GbldOYWNJaG1MSFN3WFlXb1dWYnV5V0k3V1NTYlZHRkFvVWFXX2VYUQ&amp;q=https%3A%2F%2Fwww.grassrootshealth.net%2Fblog%2Fgranulomatous-disorders-vitamin-d-hypersensitivity%2F&amp;v=mGDvmVhrVQw\"><span style=\"font-weight: 400;\"> https:\/\/www.grassrootshealth.net\/blog&#8230;<\/span><\/a><\/p>\n<p><span style=\"font-weight: 400;\">Vitamin D and COVID 19: The Evidence for Prevention and Treatment of Coronavirus (MedCram) |<\/span><a href=\"https:\/\/www.youtube.com\/watch?v=ha2mLz-Xdpg&amp;t=0s\"><span style=\"font-weight: 400;\"> https:\/\/youtu.be\/ha2mLz-Xdpg<\/span><\/a><\/p>\n<p><span style=\"font-weight: 400;\">ECG \/ EKG Interpretation Explained Clearly (MedCram) |<\/span><a href=\"https:\/\/www.youtube.com\/redirect?event=video_description&amp;redir_token=QUFFLUhqbnhvVlotZjByblhTbHAyMURiT1ptSnNOemxTQXxBQ3Jtc0tuRUpuaGwxbnVpaFdpcEdCeVRXVVF2d0t1dEQ1SVZjWDZGZFA2UHI2T3JKVHdmRUVQSjFrNzFpRFpLZnp0aDlwUmQ5elVLdWZMUTI4Vk1ROU5PdmRXNjBLemtvUkZxdjZIandySFBkUDl1TUJjZ0V3NA&amp;q=https%3A%2F%2Fwww.medcram.com%2Fcourses%2Fekg-ecg-interpretation-explained-clearly&amp;v=mGDvmVhrVQw\"><span style=\"font-weight: 400;\"> https:\/\/www.medcram.com\/courses\/ekg-e&#8230;<\/span><\/a><\/p>\n<p><span style=\"font-weight: 400;\">Additional updates are available at MedCram.com (including more discussion on vitamin-D and more).<\/span><\/p>\n<h2><b>Stay Tuned for More Updates\u00a0<\/b><\/h2>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">Our COVID-19 videos are always available for <\/span><i><span style=\"font-weight: 400;\">free <\/span><\/i><span style=\"font-weight: 400;\">(and ad-free) at<\/span><a href=\"https:\/\/www.medcram.com\/collections?category=covid-19-SARS-CoV-2\"> <span style=\"font-weight: 400;\">MedCram.com<\/span><\/a><span style=\"font-weight: 400;\">. In addition, check out our full library of courses and lectures on subjects ranging from<\/span> <a href=\"https:\/\/www.medcram.com\/courses\/hypertension-explained-clearly-2\"><span style=\"font-weight: 400;\">Hypertension Explained Clearly<\/span><\/a><span style=\"font-weight: 400;\"> to<\/span><a href=\"https:\/\/www.medcram.com\/courses\/sleep-apnea-explained-clearly\"> <span style=\"font-weight: 400;\">Sleep Apnea Explained Clearly<\/span><\/a><span style=\"font-weight: 400;\"> Course and many more!<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Meanwhile, you can find all of our COVID-19 videos compiled <\/span><a href=\"https:\/\/www.medcram.com\/collections?category=covid-19-SARS-CoV-2\"><span style=\"font-weight: 400;\">here<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Visit <\/span><a href=\"https:\/\/www.medcram.com\/\"><span style=\"font-weight: 400;\">MedCram.com<\/span><\/a><span style=\"font-weight: 400;\"> for updates on Monkeypox virus infectious disease and more.<\/span><\/p>\n<!-- AddThis Advanced Settings generic via filter on the_content --><!-- AddThis Share Buttons generic via filter on the_content -->","protected":false},"excerpt":{"rendered":"<p>In this video, Dr. Seheult of MedCram discusses a case report of an individual who had severe vitamin D toxicity. This video\u2019s 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.\u00a0 Case report&hellip;<!-- AddThis Advanced Settings generic via filter on get_the_excerpt --><!-- AddThis Share Buttons generic via filter on get_the_excerpt --><\/p>\n","protected":false},"author":8,"featured_media":1249,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[13],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v21.7 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Vitamin D toxicity: Rare but real case - Medcram Blog<\/title>\n<meta name=\"description\" content=\"In this video, Dr. Seheult of MedCram discusses a case report of an individual who had severe vitamin D toxicity. 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