Vitamin D Intoxication with Hypercalcemia Due to Overuse of Supplement

  • MohammadBagher Oghazian Clinical Pharmacy Department, Faculty of Pharmacy and Pharmaceutical Sciences, Tehran University of Medical Sciences, Tehran, Iran AND Pharmaceutical Care Department, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Sara Ataei Pharmaceutical Care Department, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Mania Radfar Mail Clinical Pharmacy Department, Faculty of Pharmacy and Pharmaceutical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
Keywords:
Hypervitaminosis D, Hypercalcemia, Vitamin D toxicity

Abstract

We describe a patient with hypercalcemia associated with the injection of high doses vitamin D as supplement for a period of six months. A 76-year-old woman had been taking an intramuscular injection of vitamin D 300,000 IU every ten days for six months. She was hospitalized with symptoms of hypercalcemia: chronic constipation, unstable gait, a chronic generalized musculoskeletal pain and increased fatigue. On admission her 25 (OH) vitamin D and Calcium levels were 559 nmol/L and 13.85 mg/dL respectively, and Parathyroid Hormone (PTH) level was 7.1 pg/mL. Immediately she received diuresis therapy with saline and furosemide in conjunction with calcitonin and pamidronate. At discharge her serum calcium level was 11.5 mg/dL. To lower endogenous overproduction of calcitriol, prednisolone 20 mg/day for 10 days was administered at discharge time.

References

Hoff WV. Vitamin-D poisoning. Lancet 1980; 1(8181):1308.

Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr 1999; 69(5):842-56.

Bilezikian JP. Clinical review 51: Management of hypercalcemia. J Clin Endocrinol Metab 1993; 77(6):1445-9.

Nussbaum SR, Younger J, Vandepol CJ, et al. Single-dose intravenous therapy with pamidronate for the treatment of hypercalcemia of malignancy: comparison of 30-, 60-, and 90-mg dosages. Am J Med 1993; 95(3):297- 304.

Bringhurst FR, Demay MB, Kronenberg HM. Hormones and Disorders of Mineral Metabolism. In: Kronenberg HM, Williams Textbook of Endocrinology. Available from http://www.mdconsult.com/das/book/ body/224568056-8/1075882147/1555/168.html#4-u1.0-B978-1-4160- 2911-3.50029-7-cesec32_2499 Accessed October 29, 2010.

Institute of Medicine. Report at a Glance, Report Brief: Dietary Reference Intakes for Calcium and Vitamin D, released 11/30/2010; Available from: URL: http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for- Calcium-and-Vitamin-D/Report-Brief.aspx (Accessed on December 01, 2010).

Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 1997; 337(10):670-6.

Dawson-Hughes B. Calcium and vitamin D nutritional needs of elderly women. J Nutr 1996; 126(4 Suppl.):1165S-7S.

Chapuy MC, Arlot ME, Duboeuf F, et al. Vitamin D3 and calcium to prevent hip fractures in the elderly woman. N Engl J Med 1992; 327(23):1637-42.

Adams JS, Lee G. Gains in bone mineral density with resolution of vitamin D intoxication. Ann Intern Med 1997; 127(3):203-6.

Woolliscroft JO. Megavitamins: fact and fancy. Dis Mon 1983; 29(5):1-56

Mason RS, Lissner D, Grunstein HS, Posen S. A simplified assay for dihydroxylated vitamin D metabolites in human serum: application to hyper- and hypovitaminosis D. Clin Chem 1980; 26(3):444-50.

Gertner JM, Domenech M. 25-hydroxyvitamin D levels in patients treated with high-dosage ergo- and cholecalciferol. Clin Pathol 1977; 30(2):144-50.

Hughes MR, Baylink DJ, Jones PG, Haussler MR. Radioligand receptor assay for 25-hydroxyvitamin D2/D3 and 1 alpha, 25- dihydroxyvitamin D2/ D3. J Clin Invest 1976; 58(1):61-70.

Rizzoli R, Stoermann C, Ammann P, Bonjour JP. Hypercalcemia and hyperosteolysis in vitamin D intoxication: effects of clodronate therapy. Bone 1994; 15(2):193-8.

Vieth R.The mechanisms of vitamin D toxicity. Bone Miner 1990; 11(3):267-72.

Jacobus CH, Holick MF, Shao Q, et al. Hypervitaminosis associated with drinking milk. N Engl J Med 1992; 326(18):1173-7.

The Relationship Between Serum 25(OH) D and Parathyroid Hormone Levels. Saliba W, Barnett O, Rennert HS, Lavi I, Rennert G. Am J Med 2011; 124(12):1165-70.

Hosking DJ, Cowley A, Bucknall CA. Rehydration in the treatment of severe hypercalcaemia. Q J Med 1981; 50(200):473-81.

Suki WN, Yium JJ, Von Minden M, et al. Acute treatment of hypercalcemia with furosemide. N Engl J Med 1970; 283(16):836-40.

Wisneski LA. Salmon calcitonin in the acute management of hypercalcemia. Calcif Tissue Int 1990; 46 Suppl: S26-30.

Austin LA, Heath H 3rd. Calcitonin: physiology and pathophysiology. N Engl J Med 1981; 304(5):269-78.

Deftos LJ, First BP. Calcitonin as a drug. Ann Intern Med 1981; 95(2):192-7

McIntyre HD, Cameron DP, Urquhart SM, Davies WE. Immobilization hypercalcaemia responding to intravenous pamidronate sodium therapy. Postgrad Med J 1989; 65(762):244-6.

Carano A, Teitelbaum SL, Konsek JD, et al. Bisphosphonates directly inhibit the bone resorption activity of isolated avian osteoclasts in vitro. J Clin Invest 1990; 85(2):456-61.

Shane, E, Dinaz, I. Hypercalcemia: pathogenesis, clinical manifestations, differential diagnosis, and management. In: Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism (Sixth Edition). American Society of Bone and Mineral Research 2006; 179.

Published
2015-10-10
How to Cite
1.
Oghazian M, Ataei S, Radfar M. Vitamin D Intoxication with Hypercalcemia Due to Overuse of Supplement. J Pharm Care. 1(3):114-116.
Section
Case Report(s)