II. Pathophysiology
- Excessive Vitamin D manifests as Hypercalcemia
- Risk of Nephrolithiasis, soft tissue calcification, Renal Injury, cardiovascular injury
- Toxicity requires chronic ingestions of large amounts of Vitamin D
- Toxic ingestion Levels
- Acute (ingestion >100 fold higher than RDA)
- Toddler: >2.5 million units
- Adult: >4.0 million units
- Chronic
- Child: >2000 units/day
- Adult: >75,000 units/day
- Acute (ingestion >100 fold higher than RDA)
III. Risk Factors
- See Hypercalcemia
- Primary Hyperparathyroidism
- Sarcoidosis or other Granulomatous conditions
- Cancers associated with Hypercalcemia
IV. Symptoms
- See Hypercalcemia
- Gastrointestinal
- Cardiopulmonary
- Hypertension
- Arrhythmias
- Prolonged QRS
- Short QTc
- Neurologic
- Metabolic
V. Labs
- See Unknown Ingestion
-
Electrolytes
- Including Creatinine and eGFR, Serum Calcium and Serum Phosphorus
- Serum Alkaline Phosphatase normal or low
-
Vitamin D (25-HydroxyVitamin D)
- May be elevated >80-100 ng/ml
- Urinalysis
VI. Diagnostics
-
Electrocardiogram (observe for Hypercalcemia changes)
- Short QT Interval
- Prolonged PR Interval (first degree AV Block)
- Wide QRS Complex
- Bradycardia
VII. Management
- See Hypercalcemia
- See Unknown Ingestion
- Consider Activated Charcoal for ingestion within prior hour and controlled airway
- Indicated for large ingestion (>100 times RDA, 17 rodenticide pellets)
-
Intravenous Fluids and intravenous Furosemide
- Forced diuresis
- Manage Seizures
- Benzodiazepines are primary agents
- See Status Epilepticus
- Severe, refractory Hypercalcemia
- Consider Hemodialysis (with Calcium-free dialysate)
- Consider Prednisone
- Consider Bisphosphonates
- Disposition
- Minor ingestions may be monitored at home
- Acute Overdose
- Monitor for 4 to 6 hours after ingestion
- Severe Hypercalcemia or neurologic effects
- Hospital monitoring
VIII. References
- Tomaszeski (2022) Crit Dec Emerg Med 36(1): 28
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Injury or Poisoning (T037) |
| SnomedCT | 67053002, 190969000, 10553007, 27712000 |
| English | HYPERVITAMINOSIS D <VITAMIN D INTOXICATION>, vitamin D toxicity (diagnosis), vitamin D toxicity, toxicity from vitamin D, HYPERVITAMINOSIS D VITAMIN D INTOXICATION, d toxicity vitamin, vitamin d intoxication, vitamin d poisoning, hypervitaminosis d, vitamin d toxicity, Poisoning by vitamin D, Vitamin D intoxication (disorder), Vitamin D intoxication, Vitamin D toxicity, Vitamin D poisoning, Poisoning by vitamin D (disorder) |
| Spanish | intoxicación con vitamina D (trastorno), intoxicación con vitamina D, intoxicación por vitamina D (trastorno), intoxicación por vitamina D, toxicidad por vitamina D |
Ontology: Cholecalciferol toxicity (C0275058)
| Concepts | Injury or Poisoning (T037) |
| SnomedCT | 49929007 |
| English | Cholecalciferol toxicity, Cholecalciferol toxicity (disorder) |
| Spanish | intoxicación por colecalciferol (trastorno), intoxicación por colecalciferol, toxicidad del colecalciferol |
Ontology: Vitamin D overdose (C0573817)
| Concepts | Injury or Poisoning (T037) |
| SnomedCT | 296953002 |
| English | vitamin d overdose, Vitamin D overdose, Vitamin D overdose (disorder) |
| Spanish | sobredosis de vitamina D (trastorno), sobredosis de vitamina D |
