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Vitamin D – which exists in two forms: D2 (ergocalciferol) and D3 (cholecalciferol) – helps regulate the amount of calcium and phosphate in the body. Vitamin D toxicity is rare, but patients and clinicians need to be aware of the risks of using vitamin D to limit the complications of hypercalcemia, according to a new case study.
The simplified pathway of vitamin D metabolism with a suggested approach to the management of hypervitaminosis D. The key steps are as follows: limit exposure to the sun; stop oral vitamin D supplements; use drugs such as corticosteroids, ketoconazole and hydroxychloroquine to block the activity of 1α-hydroxylase; Stop oral calcium supplements to reduce the burden of hypercalcemia badociated with hypervitaminosis D. The main enzymes involved in the metabolic pathway are indicated in green. Image credit: Auguste et al, doi: 10.1503 / cmaj.180465 / Creativology / BSG Studio.
A 54-year-old man, after returning from a trip to Southeast Asia where he had spent most of his two-week vacation tanning (6-8 hours a day), presented an increase creatinine levels, suggesting lesions or kidney dysfunction "Bourne Auguste, of the University of Toronto, and his coauthors, Toronto General Hospital and the University of Toronto.
"After consulting with a kidney specialist and other tests, it was discovered that a naturopath had prescribed him high doses of vitamin D, which had recommended a dose of 8 drops a day. "
In two and a half years, the patient, who had no history of bone loss or vitamin D deficiency, took 8 to 12 drops of vitamin D per day, for a total of 8,000 to 12,000 IU.
As a result, his blood calcium level was very high, which caused him significant kidney damage.
"Although the toxicity of vitamin D is rare because of a wide therapeutic range, its widespread availability in various over-the-counter formulations can pose a significant risk to uninformed patients," said Dr. Auguste.
The recommended daily allowance is 400 to 1,000 IU, with 800 to 2,000 IU being recommended for adults at high risk of osteoporosis and for the elderly.
"Our experience tells us that patients and clinicians should be better informed about the risks badociated with the unhindered use of vitamin D," the researchers concluded.
The case study was published online this week in the journal Journal of the Canadian Medical Association.
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Bourne L. Auguste et al. 2019. Use of vitamin D drops leading to kidney failure in a 54-year-old man. CMAJ 191 (14): E390-E394; doi: 10.1503 / cmaj.180465
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