Hypercalcemia, hypervitaminosis A and 3-epi-25-OH-D3 levels after consumption of an “over the counter” vitamin D remedy. A case report

• Published in: Food and chemical toxicology 2012-06, Vol.50 (6), p.2106-2108
• Main Authors: Granado-Lorencio, F., Rubio, E., Blanco-Navarro, I., Pérez-Sacristán, B., Rodríguez-Pena, R., García López, F.J.
• Format: Article
• Language: English
• Subjects: 25-Hydroxyvitamin D; 25-Hydroxyvitamin D 2 - blood; Acute kidney injury; Acute Kidney Injury - chemically induced; adults; Biological and medical sciences; blood serum; C-3 epimer of 25-hydroxyvitamin D; Calcifediol - blood; case studies; Chromatography, High Pressure Liquid; Dietary Supplements; drug therapy; Female; Humans; hypercalcemia; Hypercalcemia - blood; Hypercalcemia - chemically induced; Hypervitaminosis A; Hypervitaminosis A - blood; Hypervitaminosis A - chemically induced; Kidneys; Medical Errors; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; patients; poisoning; Quality Control; renal failure; Toxicology; Urinary system involvement in other diseases. Miscellaneous; vitamin A; Vitamin A - blood; vitamin D; Vitamin D - adverse effects; Vitamin D toxicity; vitamin status; Vitamins - adverse effects
• ISSN: 0278-6915; 1873-6351
• DOI: 10.1016/j.fct.2012.03.001

Intoxication from vitamin D supplements has been rarely reported but, nowadays, it occurs more frequently. 3-epi-25-OH-D3 is highly prevalent in adults and it is considered of biological relevance. We report a case of vitamin D toxicity with hypercalcemia, acute renal failure and hypervitaminosis A after consuming an over-the-counter vitamin D supplement. Our data suggest that the contribution of 3-epi-25-OH-D3 is not altered during vitamin D toxicity, although the serum levels of 25-OH-D3 and 3-epi-25-OH-D3 may display a different rate of clearance. The patient also displayed hypervitaminosis A unrelated to diet, possibly caused by renal failure related to the hypercalcemia induced by vitamin D toxicity. Because of the increasing use of over-the-counter vitamin D supplements and the potential iatrogenic hypercalcemia related to hypervitaminosis A, the present case highlights the importance of evaluating both the use of (non-) prescribed medication and vitamin A status during vitamin D toxicity.