Patients can overdose on vitamin D supplements with “debilitating” consequences, a doctor has warned.
Dr Alamin Alkundi of East Kent Hospitals University NHS Foundation Trust, UK, and colleague write in BMJ Case Reports that: "The multisystemic clinical manifestations of vitamin D toxicity can be debilitating, hence the need to prevent its occurrence."
They explain that the health outcomes of over-the-counter nutritional supplements remain controversial. As the research evidence on ‘hypervitaminosis D’ or vitamin D toxicity is limited, they highlight the issue in this case report.
The patient was a middle-aged man, referred to hospital by a GP after nearly three months of vomiting, nausea, abdominal pain, leg cramps, tinnitus, dry mouth, increased thirst, diarrhoea, and weight loss.
He began a vitamin regimen therapy on the advice of a private nutritionist one month previously, including vitamin D at 150,000 IU, together with several other vitamins at doses far exceeding the guidelines. The daily requirement is 400 IU.
On stopping the supplements, his symptoms persisted, and tests showed acute kidney injury. After eight days on hospital and intravenous fluids plus bisphosphonates to lower excess blood calcium, he was discharged and a month later his calcium level was normal, but vitamin D remained abnormally high.
"A review of this case, supported by accumulated literature, lends room to further public health safety discussions," the authors write.
"Considering this topic, issues such as the potential interaction of over-the-counter and prescribed medications, market regulations of nutritional supplements, the misuse of these supplements in sports, and the potential harm among unsuspecting population groups (e.g. children and the elderly) remain matters of public health significance that need to be addressed," they conclude.
Alkundi, A. et al. Case report: Vitamin D intoxication and severe hypercalcaemia complicating nutritional supplements misuse. BMJ Case Reports 6 July 2022; doi: 10.1136/bcr-2022-250553
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