Biochemical characteristics and calcium and PTH levels of patients with high normal and elevated serum 25(OH)D levels in Turkey: DeVIT-TOX survey
Arch Osteoporos. 2021 Sep 18;16(1):138. doi: 10.1007/s11657-021-01002-8.
Zafer Pekkolay 1, Dilek Gogas Yavuz 2, Emre Sedar Saygılı 3, Ceyla Konca Değertekin 4, Ömercan Topaloğlu 5, Çağatay Emir Önder 6, Hikmet Soylu 7, Işılay Taskaldıran 6, Ayşe Esen Pazır 8, Kader Uğur 9, Seher Tanrıkulu 10, Sevde Nur Fırat 6, Burcu Meryem Atak 11, Adnan Batman 12, Tülay Omma 6, Eylem Cağıltay 13, Nilüfer Özdemir 14, Seher Çetinkaya Altuntaş 15, Narin Nasıroğlu İmga 16, Ersen Karakılıç 3, Zeliha Hekimsoy 14, Faruk Kılınç 9, Adnan Yay 13, Mustafa Eroğlu 17, Alpaslan Kemal Tuzcu 18
Overview Toxicity of vitamin D has the following chart
Items in both categories Toxicity and Calcium are listed here:
- Some people taking 1 million IU of Vitamin D were hypercalcemic for a while – Sept 2021
- Very rarely vitamin D can cause excess Calcium – a simple diagnostic - April 2021
- 10,000 IU of Vitamin D for 7 years with no excessive Calcium in 4,800 patients – Dec 2018
- Vitamin D accumulation in 1 in 300 people due to gene (CYP24A1) can cause Calcium problems – June 2018
- Controversy: Too much Calcium if increase Vitamin D
- IoM again fails to look at interactions - Nov 2010
- Constipation - Magnesium, Calcium and cofactors
- Rare case of 3000 IU vitamin D being toxic – hypercalcemia April 2010
Vitamin D intake over the recommended dose is usually associated with high serum 25(OH)D levels and generally not associated with symptoms of hypercalcemia. High doses of cholecalciferol need to be avoided to protect against vitamin D toxicity and related complications. Strict adherence to the clinical guidelines for treating vitamin D deficiency can ensure safe and effective treatment.
Purpose: We observed a tendency to use high doses of cholecalciferol for vitamin D deficiency treatment or vitamin D supplementation. We aimed to determine the biochemical characteristics of patients with high normal and elevated serum 25(OH)D levels.
Methods: An online invitation was sent to all tertiary endocrinology clinics in Turkey to complete an online retrospective survey (DeVIT-TOX Survey) for patients diagnosed with high serum 25(OH)D levels (> 88 ng/mL) between January 2019 and December 2019. The patients were evaluated according to the presence of signs and symptoms of hypercalcemia and doses of vitamin D intake, evaluated into the following three groups according to their 25(OH)D levels: group 1, > 150 ng/mL; group 2, 149-100 ng/mL; and group 3, 99-88 ng/mL.
Results: A total of 253 patients were included in the final analysis (female/male: 215/38; mean age, 51.5 ± 15.6 years). The average serum 25(OH)D level was 119.9 ± 33 (range, 88-455) ng/mL, and the average serum calcium level was 9.8 ± 0.7 (range, 8.1-13.1) mg/dL. Most (n = 201; 75.4%) patients were asymptomatic despite having high serum 25(OH)D and calcium levels. The serum 25(OH)D level was significantly higher in the symptomatic groups than in the asymptomatic groups (138.6 ± 64 ng/mL vs. 117.7 ± 31 ng/mL, p < 0.05).
The most common cause (73.5%) associated with high serum 25(OH)D levels was the inappropriate prescription of a high dose of oral vitamin D (600.000-1.500.000 IU) for treating vitamin D deficiency/insufficiency in a short time (1-3 months). The cut-off value of 25 (OH) D level in patients with hypercalcemia was found to be 89 ng/mL [median 116.5 (89-216)].
Conclusions: High dose of vitamin D intake is associated with a high serum 25 OH D level, without symptoms of hypercalcemia. Inappropriate prescription of vitamin D is the primary cause for elevated 25(OH) D levels and related hypercalcemia. Hypercalcemia may not be observed in every patient at very high 25(OH) D levels. Adherence to the recommendation of guidelines is essential to ensure safe and effective treatment of vitamin D deficiency.
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