Pharmacology Book


Vitamin D Toxicity

Aka: Vitamin D Toxicity, Hypervitamin D, Vitamin D Overdose, Vitamin D Poisoning, Cholecalciferol Toxicity
  1. See Also
    1. Vitamin D
    2. Vitamin D Deficiency
  2. Pathophysiology
    1. Excessive Vitamin D manifests as Hypercalcemia
      1. Risk of Nephrolithiasis, soft tissue calcification, Renal Injury, cardiovascular injury
    2. Toxicity requires chronic ingestions of large amounts of Vitamin D
      1. Vitamin D has been subject of dubious claims such as Covid19 prevention (no evidence of benefit, risk of harm)
      2. High Vitamin D concentrations have been used as a rodenticide
    3. Toxic ingestion Levels
      1. Acute (ingestion >100 fold higher than RDA)
        1. Toddler: >2.5 million units
        2. Adult: >4.0 million units
      2. Chronic
        1. Child: >2000 units/day
        2. Adult: >75,000 units/day
  3. Risk Factors
    1. See Hypercalcemia
    2. Primary Hyperparathyroidism
    3. Sarcoidosis or other Granulomatous conditions
    4. Cancers associated with Hypercalcemia
  4. Symptoms
    1. See Hypercalcemia
    2. Gastrointestinal
      1. Nausea or Vomiting
      2. Abdominal cramps
    3. Cardiopulmonary
      1. Hypertension
      2. Arrhythmias
      3. Prolonged QRS
      4. Short QTc
    4. Neurologic
      1. Dizziness
      2. Headaches
      3. Irritability
      4. Fatigue
      5. Seizures
    5. Metabolic
      1. Hypercalcemia
      2. Renal Failure
  5. Labs
    1. See Unknown Ingestion
    2. Electrolytes
      1. Including Creatinine and eGFR, Serum Calcium and Serum Phosphorus
    3. Vitamin D (25-HydroxyVitamin D)
      1. May be elevated >80-100 ng/ml
    4. Urinalysis
  6. Diagnostics
    1. Electrocardiogram (observe for Hypercalcemia changes)
      1. Short QT Interval
      2. Prolonged PR Interval (first degree AV Block)
      3. Wide QRS Complex
      4. Bradycardia
  7. Management
    1. See Hypercalcemia
    2. See Unknown Ingestion
    3. Consider Activated Charcoal for ingestion within prior hour and controlled airway
      1. Indicated for large ingestion (>100 times RDA, 17 rodenticide pellets)
    4. Intravenous Fluids and intravenous Furosemide
      1. Forced diuresis
    5. Manage Seizures
      1. Benzodiazepines are primary agents
      2. See Status Epilepticus
    6. Severe, refractory Hypercalcemia
      1. Consider Hemodialysis (with Calcium-free dialysate)
      2. Consider Prednisone
      3. Consider Bisphosphonates
    7. Disposition
      1. Minor ingestions may be monitored at home
      2. Acute Overdose
        1. Monitor for 4 to 6 hours after ingestion
      3. Severe Hypercalcemia or neurologic effects
        1. Hospital monitoring
  8. References
    1. Tomaszeski (2022) Crit Dec Emerg Med 36(1): 28

Poisoning by vitamin D (C0242154)

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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