Int J Clin Pract. 2021 Mar 24;e14181. doi: 10.1111/ijcp.14181
Adnan Batman 1, Emre Sedar Saygili 1, Duygu Yildiz 1, Esra Cil Sen 1, Rumeysa Selvinaz Erol 1, Muhammed Masum Canat 1, Feyza Yener Ozturk 1, Yuksel Altuntas 1
The patients probably avoided hypercalcemia by doing one or more of the following:
- Drank lots of water
- Did not supplement with Calcium from rocks (Calcium from plants appears to be OK)
- Had an adequate amount of vitamin K in their diet
- Had an adequate amounf of Magnesium in their diet or from hard water
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 1,311 (0.5 %) patients had very high 25(OH)D levels (>88 ng/ml). 495 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=0.01), but no correlation between 25(OH)D and calcium levels was observed. Alkaline phosphatase (ALP) levels were significantly higher in males (p = 0.032), and age and iPTH levels were higher in females (p<0.001 and p=0.004). ALP, phosphorus levels, and iPTH suppression rates were higher in hypercalcemic patients (p<0.001, p<0.001, and p<0.001, respectively), while the iPTH level was significantly lower in hypercalcemic patients (p<0.001) than in normocalcemic patients. Among the three groups with different 25(OH)D levels, no difference was found in levels of iPTH, calcium, phosphorus, ALP, or age.