“Hypervitamin D” is on the rise and is associated with a wide range of potentially serious health problems. Doctors are warning that “overdosing” on vitamin D supplements is both possible and harmful after treating a man who needed to be admitted to hospital for excessive vitamin D intake. They reported their concerns in the journal BMJ Case Reports. They point out that “hypervitaminosis D,” as the condition is officially known, is on the rise and has been linked to a wide variety of potentially serious health conditions. This case involves a middle-aged man who was referred to the hospital by his family doctor after complaints of repeated vomiting, nausea, leg cramps, abdominal pain, increased thirst, dry mouth, tinnitus (ringing in the ear), diarrhea, and weight loss (28 pounds or 12.7 kg). Symptoms of hypervitaminosis D include drowsiness, depression, confusion, anorexia, apathy, psychosis, abdominal pain, coma, vomiting, peptic ulcer, constipation, pancreatitis, abnormal heart rhythm, high blood pressure, and kidney abnormalities, including kidney failure. These symptoms had been present for almost 3 months and had started about 1 month after he started an intensive vitamin supplement regimen on the advice of a nutritionist. The man had various underlying health problems, including tuberculosis, bacterial meningitis, a tumor in the inner ear (left vestibular schwannoma), which resulted in deafness in that ear, a build-up of fluid on the brain (hydrocephalus), and chronic sinusitis. He was high-dose with more than 20 over-the-counter supplements each day that contained: vitamin D 50,000 mg—the daily requirement is 600 mg or 400 IU; vitamin K2 100 mg (daily requirement 100–300 µg). vitamin C, vitamin B9 (folic acid) 1,000 mg (daily requirement 400 μg). vitamin B2 (riboflavin), vitamin B6, omega-3 2,000 mg twice daily (200–500 mg daily requirement), plus many other vitamin, mineral, nutrient and probiotic supplements. Once his symptoms appeared, he stopped taking his daily cocktail of supplements, but his symptoms did not go away. Blood tests ordered by his family doctor showed that he had extremely high calcium levels and slightly elevated magnesium levels. And his vitamin D level was seven times higher than what was necessary for sufficiency. Tests also revealed that his kidneys were not working properly (acute kidney injury). The results of various x-rays and scans to check for cancer were normal. The man stayed in hospital for 8 days, during which he was given IV fluids to flush out his system and treated with bisphosphonates – drugs commonly used to strengthen bones or reduce excessive calcium levels in the blood. Two months after leaving the hospital, his calcium levels had returned to normal, but his vitamin D levels were still abnormally high. “Globally, there is an increasing trend of hypervitaminosis D, a clinical condition characterized by elevated serum vitamin D3 levels,” with women, children and surgical patients more likely to be affected, the authors write. Vitman D sources include oily fish, sunlight exposure, and supplements. Recommended levels of vitamin D can be obtained from diet (eating wild mushrooms and oily fish), skin exposure to sunlight, and dietary supplements. “Given its slow turnover (half-life of about 2 months), during which vitamin D toxicity develops, symptoms may persist for several weeks,” the authors warn. The symptoms of hypervitaminosis D are many and varied, they point out, and are mainly caused by excess calcium in the blood. They include confusion, drowsiness, apathy, psychosis, anorexia, depression, coma, vomiting, abdominal pain, constipation, peptic ulcers, lethargy, pancreatitis, abnormal heart rhythm, high blood pressure, and kidney abnormalities, including kidney failure. Other associated features, such as keratopathy (inflammatory eye disease), joint stiffness (arthralgia), and hearing loss or deafness, have also been reported, they add. This is just one case, and while hypervitaminosis D is on the rise, it’s still relatively uncommon, the authors caution. However, complementary therapy, including the use of dietary supplements, is popular and people may not realize that it is possible to overdose on vitamin D or the potential consequences of it, they say. “This case report further highlights the potential toxicity of supplements that are considered largely safe until they are taken in unsafe amounts or in unsafe combinations,” they conclude. Citation: “Vitamin D poisoning and severe hypercalcemia complicating nutritional supplement misuse” 5 July 2022, BMJ Case Reports.DOI: 10.1136/bcr-2022-250553
