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Hypervitaminosis D rarely causes hypercalcemia: new concept subclinical intoxication

Year 2018, Volume: 10 Issue: 2, 165 - 167, 15.08.2018
https://doi.org/10.18521/ktd.396175

Abstract

Aim: D vitamins have been
used by physicians and the public more often than usual in recent years. D
vitamin intoxication 25 OH vitamin D level> 150 μg / L calcium level>
10.5 mg / dl is defined as. In clinical practice, hypercalcemia may not be
observed at very high 25 OH vitamin D levels. The reason for this is unknown.
The purpose of this  study is to
investigate 
the percentage
of hypercalcemia in patients with very high 25 OH D levels.

Material-Methods: Between
January 1, 2016 and October 31, 2017, 22996 patients who were referred to
hospital and examined 25 OH vitamin D levels from all patients were screened at
the Dicle University Medical Faculty Hospital. Patients with 25 OH vitamin D
levels> 150 μg / L were included in the study. The calcium, phosphorus,
creatinine, albumin and parathormone values of these patients, if any, were checked.
Rates of hypercalcemia in patients with hypervitaminosis D were evaluated. The
vitamin D preparations they used were recorded. Vitamin D was measured by HPLC
method. Ethical committee opinion was taken for the study.

Results: The number of patients
with vitamine D> 150 μg / L was approximately 1/1000 (0.0013%). Age 56 ± 20
(24-90). More frequent in females 21 K 6 E (78/12%). 25 OH Vitamin D 184.81 ±
35.37 (150.51-279.64) μg /L, and D vitamine levels after replacement were
measured after 2.10 ± 1.58 months. Calcium 9.48 ± 0.52 (8.4-10.9) mg /dL.
Percentage of hypercalcemia in patients with vitamin D> 150 μg /L was 3.70.







Conclusion: As a
result, very high levels of vitamin D do not show toxicity. When vitamin D
level is above the level of toxicity, calcium and phosphorus control should be
performed. Very high vitamin D levels are often attributed to too much ampoule use. Close follow-up and appropriate dose treatment of the
patients will solve this problem. There is a need for studies involving a large
number of patients with randomized controlled, multicenter, genetic and
metabolic parameters for the correct definition of vitamin D toxicity.

References

  • 1- Hilger, J., Friedel, A., Herr, R. et al. (2014) A systematic review of vitamin D status in populations worldwide. British Journal of Nutrition, 111, 23–45.2- S. Newberry, M. Chung, P.G. Shekelle, et al., Vitamin D and Calcium: A Systematic Review of Health Outcomes (Update). Evidence Report/Technology Assessment No. 217. (Prepared by the Southern California Evidence-based Practice Center Under Contract No. 290-2012-00006-I.) AHRQ Publication No. 14-E004-EF, Agency for Healthcare Research and Quality, Rockville, MD, 2014.3- Kaur P, Mishra SK, Mithal A. Vitamin D toxicity resulting from overzealous correction of vitamin D deficiency. Clin Endocrinol (Oxf) 2015;83:327–31.4- B. Ozkan, S. Hatun, A. Bereket Vitamin D intoxication Turk. J. Pediatr., 54 (2012), pp. 93-985- M.F. Holick, N.C. Binkley, H.A. Bischoff-Ferrari, C.M. Gordon, D.A. Hanley, R.P. Heaney, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline J. Clin. Endocrinol. Metab., 96 (7) (2011), pp. 1911-19306- Pérez-Barrios C, Hernández-Álvarez E, Blanco-Navarro I, Pérez-Sacristán B, Granado-Lorencio F. Prevalence of hypercalcemia related to hypervitaminosis D in clinical practice. Clin Nutr. 2016 Dec;35(6):1354-1358. doi: 10.1016/j.clnu.2016.02.017.7- Awumey EM, Mitra DA, Hollis BW et all. Vitamin D metabolism is altered in Asian Indians in the southern United States: a clinical research center study. J Clin Endocrinol Metab 1998;83:169-738- Curran JS, Barness LA. Hypervitaminosis D. In: Behrman RE, Kliegman RM, Jenson HB, editors. Nelson Textbook of Pediatrics. Philadelphia: WB Saunders 2000. p. 87-8.9- Shea RL, Berg JD. Self-administration of vitamin D supplements in the general public may be associated with high 25-hydroxyvitamin D concentrations. Ann Clin Biochem. 2017 May;54(3):355-361. doi: 10.1177/0004563216662073. 10- Scragg R. Vitamin D and public health: an overview of recent research on common diseases and mortality in adulthood. Publ Health Nutr 2011;14: 1515e32

Hipervitaminoz D Nadiren Hiperkalsemi Yapar: Subklinik İntoksikasyon

Year 2018, Volume: 10 Issue: 2, 165 - 167, 15.08.2018
https://doi.org/10.18521/ktd.396175

Abstract

Amaç: D vitamini son yıllarda hekimler ve halk tarafından genelde gereğinden fazla kullanılmaktadır. D vitamini intoksikasyonu 25 OH vitamin D düzeyi >150 µg/L kalsiyum düzeyi >10.5 mg/dl olarak tanımlanmaktadır.  Klinik pratikte çok yüksek 25 OH vitamin D değerlerinde hiperkalsemi gözlenmeyebilir. Bunun nedeni bilinmemektedir. Bu çalışmada amacımız çok yüksek 25 OH vitamin D düzeyi olan hastalardaki hiperkalsemi yüzdesini ortaya çıkarmaktır.

Materyal-metod: Dicle Üniversitesi Tıp Fakültesi Hastanesine  1 ocak 2016 ile 31 Ekim 2017 tarihleri arasında tüm bölümlere başvuran ve yatan hastalardan 25 OH vitamin D düzeyine bakılan  22996 hasta tarandı. 25 OH vitamin D düzeyi >150 µg/L olan hastalar çalışmaya alındı. Bu hastaların eğer varsa veri tabanımızdaki kalsiyum, fosfor, kreatinin, albumin ve parathormon değerlerine bakıldı. Hipervitaminoz D hastalarındaki hiperkalsemi oranlarına bakıldı. Kullandıkları D vitamini preperatı kaydedildi. D vitamini HPLC  yöntemiyle ölçülmüştü. Çalışma için etik kurul görüşü alındı.

Sonuçlar: D vitamini >150 µg/L olan hasta sayısı 32 saptandı(32/22996 yaklaşık 1/1000). Yaş 56 ±20 (24-90), Kadınlarda daha sık gözlendi.  21 Kadın, 6 Erkek  (%78/12 ). 25 OH Vitamin D 184.81±35.37(150.51-279.64) µg/L  Kalsiyum 9.48±0.52(8.4-10.9) mg/dL. D vitamini >150 µg/L olan hastalardaki hiperkalsemi yüzdesi 3.7 saptandı.

Sonuç olarak çoğu hastada çok yüksek D vitamini düzeyleri toksikasyonu göstermemektedir. D vitamini düzeyi toksikasyon düzeyinin üzerinde saptandığında kalsiyum ve fosfor kontrolü yapılmalıdır. Çok yüksek D vitamini düzeyi genelde gereğinden çok fazla ampul formu kullanımına bağlı görülmektedir. Hastaların yakın takibi ve uygun dozda tedavisi bu problemi çözecektir. D vitamini toksikasyonunun doğru tanımı için randomize kontrollü, çok merkezli, genetik ve metabolik parametreleri içeren çok sayıda hasta içeren çalışmalara ihtiyaç vardır.

References

  • 1- Hilger, J., Friedel, A., Herr, R. et al. (2014) A systematic review of vitamin D status in populations worldwide. British Journal of Nutrition, 111, 23–45.2- S. Newberry, M. Chung, P.G. Shekelle, et al., Vitamin D and Calcium: A Systematic Review of Health Outcomes (Update). Evidence Report/Technology Assessment No. 217. (Prepared by the Southern California Evidence-based Practice Center Under Contract No. 290-2012-00006-I.) AHRQ Publication No. 14-E004-EF, Agency for Healthcare Research and Quality, Rockville, MD, 2014.3- Kaur P, Mishra SK, Mithal A. Vitamin D toxicity resulting from overzealous correction of vitamin D deficiency. Clin Endocrinol (Oxf) 2015;83:327–31.4- B. Ozkan, S. Hatun, A. Bereket Vitamin D intoxication Turk. J. Pediatr., 54 (2012), pp. 93-985- M.F. Holick, N.C. Binkley, H.A. Bischoff-Ferrari, C.M. Gordon, D.A. Hanley, R.P. Heaney, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline J. Clin. Endocrinol. Metab., 96 (7) (2011), pp. 1911-19306- Pérez-Barrios C, Hernández-Álvarez E, Blanco-Navarro I, Pérez-Sacristán B, Granado-Lorencio F. Prevalence of hypercalcemia related to hypervitaminosis D in clinical practice. Clin Nutr. 2016 Dec;35(6):1354-1358. doi: 10.1016/j.clnu.2016.02.017.7- Awumey EM, Mitra DA, Hollis BW et all. Vitamin D metabolism is altered in Asian Indians in the southern United States: a clinical research center study. J Clin Endocrinol Metab 1998;83:169-738- Curran JS, Barness LA. Hypervitaminosis D. In: Behrman RE, Kliegman RM, Jenson HB, editors. Nelson Textbook of Pediatrics. Philadelphia: WB Saunders 2000. p. 87-8.9- Shea RL, Berg JD. Self-administration of vitamin D supplements in the general public may be associated with high 25-hydroxyvitamin D concentrations. Ann Clin Biochem. 2017 May;54(3):355-361. doi: 10.1177/0004563216662073. 10- Scragg R. Vitamin D and public health: an overview of recent research on common diseases and mortality in adulthood. Publ Health Nutr 2011;14: 1515e32
There are 1 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Articles
Authors

Zafer Pekkolay 0000-0002-5323-2257

Faruk Kılınç 0000-0002-0198-2558

Şadiye Altun Tuzcu 0000-0003-3326-5358

Alpaslan Kemal Tuzcu

Publication Date August 15, 2018
Acceptance Date July 10, 2018
Published in Issue Year 2018 Volume: 10 Issue: 2

Cite

APA Pekkolay, Z., Kılınç, F., Altun Tuzcu, Ş., Tuzcu, A. K. (2018). Hipervitaminoz D Nadiren Hiperkalsemi Yapar: Subklinik İntoksikasyon. Konuralp Medical Journal, 10(2), 165-167. https://doi.org/10.18521/ktd.396175
AMA Pekkolay Z, Kılınç F, Altun Tuzcu Ş, Tuzcu AK. Hipervitaminoz D Nadiren Hiperkalsemi Yapar: Subklinik İntoksikasyon. Konuralp Medical Journal. August 2018;10(2):165-167. doi:10.18521/ktd.396175
Chicago Pekkolay, Zafer, Faruk Kılınç, Şadiye Altun Tuzcu, and Alpaslan Kemal Tuzcu. “Hipervitaminoz D Nadiren Hiperkalsemi Yapar: Subklinik İntoksikasyon”. Konuralp Medical Journal 10, no. 2 (August 2018): 165-67. https://doi.org/10.18521/ktd.396175.
EndNote Pekkolay Z, Kılınç F, Altun Tuzcu Ş, Tuzcu AK (August 1, 2018) Hipervitaminoz D Nadiren Hiperkalsemi Yapar: Subklinik İntoksikasyon. Konuralp Medical Journal 10 2 165–167.
IEEE Z. Pekkolay, F. Kılınç, Ş. Altun Tuzcu, and A. K. Tuzcu, “Hipervitaminoz D Nadiren Hiperkalsemi Yapar: Subklinik İntoksikasyon”, Konuralp Medical Journal, vol. 10, no. 2, pp. 165–167, 2018, doi: 10.18521/ktd.396175.
ISNAD Pekkolay, Zafer et al. “Hipervitaminoz D Nadiren Hiperkalsemi Yapar: Subklinik İntoksikasyon”. Konuralp Medical Journal 10/2 (August 2018), 165-167. https://doi.org/10.18521/ktd.396175.
JAMA Pekkolay Z, Kılınç F, Altun Tuzcu Ş, Tuzcu AK. Hipervitaminoz D Nadiren Hiperkalsemi Yapar: Subklinik İntoksikasyon. Konuralp Medical Journal. 2018;10:165–167.
MLA Pekkolay, Zafer et al. “Hipervitaminoz D Nadiren Hiperkalsemi Yapar: Subklinik İntoksikasyon”. Konuralp Medical Journal, vol. 10, no. 2, 2018, pp. 165-7, doi:10.18521/ktd.396175.
Vancouver Pekkolay Z, Kılınç F, Altun Tuzcu Ş, Tuzcu AK. Hipervitaminoz D Nadiren Hiperkalsemi Yapar: Subklinik İntoksikasyon. Konuralp Medical Journal. 2018;10(2):165-7.