How Much Vitamin D is Too Much? A Case Report and Review of the Literature

Background: The beneficial effects of vitamin D, together with the high prevalence of vitamin D deficiency, have led to an expanding use of vitamin D analogues. While inappropriate consumption is a recognized cause of harm, definition of doses at which vitamin D becomes toxic remain elusive. Case presentation: A 56-year woman was admitted to our Hospital following a 3-week history of nausea, vomiting and muscle weakness. The patient had been assuming very high dose of cholecalciferol since 20 months (cumulative 78,000,000UI, mean daily 130,000UI), as indicated by a non-conventional protocol for multiple sclerosis. Before starting vitamin D integration, serum calcium and phosphorus levels were normal, while 25OH-vitamin D levels were very low (12.25 nmol/L). On admission, hypercalcemia (3.23 mmol/L) and acute kidney injury (eGFR 20 mL/min) were detected, associated with high concentrations of 25OH-vitamin D (920 nmol/L), confirming the suspicion of vitamin D intoxication. Vitamin D integration was stopped and, in a week, hypercalcemia normalized. It took about 6 months for renal function and 18 months for vitamin D values to go back to normal. Conclusions: This case confirms that vitamin D intoxication is possible albeit with a really high dose. The doses used in clinical practice are far lower than these and, therefore, intoxication rarely occurs even in those individuals whose baseline vitamin D serum levels have never been assessed. Repeated measurements of vitamin D are not necessary in patients under standard integrative therapy. However, patients and clinicians should be aware of the potential dangers of vitamin D overdose.

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Evaluation of Maternal and Infantile Levels of Vitamin D in Preterm Infants

Current Pediatric Reviews ◽

10.2174/1573396317666211006153153 ◽

2021 ◽

Vol 17 ◽

Author(s):

Hassan Boskabadi ◽

Ali Moradi ◽

Maryam Zakerihamidi

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Preterm Infants ◽

Premature Infants ◽

Serum Levels ◽

Severe Deficiency ◽

Vitamin D Levels ◽

The Difference ◽

D 20 ◽

D Values

Introduction: Vitamin D deficiency is highly prevalent during pregnancy and in premature infants. This study was done to investigate the maternal and infantile levels of vitamin D in preterm infants. Methods: Using available sampling during 2018-2020 the maternal and umbilical cord serum levels of vitamin D were measured in 294 premature infants in Ghaem Hospital, Mashhad, Iran. A researcher-made questionnaire containing neonatal demographic and clinical characteristics was used as data collection tool. Both maternal and placental vitamin D levels were categorized into four classes: severe deficiency (vitamin D<10 ng/ml), moderate deficiency (10.1≤vitamin D≤20 ng/ml), mild deficiency (20.1≤vitamin D≤30 ng/ml) and normal (vitamin D >30.1ng ml). Results: Vitamin D deficiency was seen in 89% of premature infants (46.6% severe, 30.6% moderate, and 11.9% mild). Serum levels of vitamin D were 18.28±13.94 ng/ml and 14.10±9.70 ng/ml in mothers and infants, respectively. The infants below and above 32 weeks had vitamin D values of: 10.97±6.31 ng/ml and 18.05±11.64 ng/ml, respectively. The difference in vitamin D levels between boys (12.59±8.40 ng/ml) and girls (16.05±11.45 ng/ml) was significant (P=0.009). Moderate and severe vitamin D deficiency were more common at earlier pregnancy ages (P=0.001). Conclusion: Vitamin D deficiency is more common and severe in preterm infants and their mothers. Controlling vitamin D level during pregnancy, especially in women at risk of preterm labor and preterm infants may help reduce prematurity problems.

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Adequate Vitamin D Intake but Low Serum Levels in Pediatric Asthma Patients: A Pilot Study, Alberta Children’s Hospital

Canadian Respiratory Journal ◽

10.1155/2016/6982010 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Sarah Howe McKenna ◽

Tanis R. Fenton ◽

Mary Noseworthy ◽

Mark Anselmo

Keyword(s):

Vitamin D ◽

Pediatric Asthma ◽

Serum Levels ◽

High Dose ◽

Healthy Children ◽

Vitamin D Status ◽

Vitamin D Intake ◽

Vitamin D Levels ◽

Asthma Patients ◽

25 Oh Vitamin D

Background. We assessed vitamin D intakes and serum 25(OH) vitamin D levels in pediatric asthma patients on moderate-to-high dose inhaled steroids and compared them to published findings of healthy children in our city.Methods. Parents and/or patients were interviewed to estimate the children’s vitamin D intakes from foods and supplements (using an adapted validated food frequency questionnaire) and asthma duration and management. Vitamin D status: serum 25-hyroxy vitamin D (25(OH)D) was obtained from the medical records.Results. Vitamin D intakes from food and supplements of the asthma patients (n=20, 742 ± 185 IU/day) were significantly higher compared to healthy Canadian children (n=1442, 229 ± 121 IU/day). Despite higher vitamin D intakes, the children had nonsignificantly lower serum 25(OH) vitamin D levels compared to the comparison group. Serum 25(OH)D levels increased by 3.6 nmol/L with each 100 IU of vitamin D intake (95% Confidence interval = 2.0–4.0,R2= 0.931, andp=0.001).Conclusion. Since adequate vitamin D status in asthma patients is necessary to support bone mineral accretion, it is important to achieve adequate vitamin D status by checking serum 25(OH)D status and supplement accordingly.

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Effectiveness of In-Hospital Cholecalciferol Use on Clinical Outcomes in Comorbid COVID-19 Patients: A Hypothesis-Generating Study

Nutrients ◽

10.3390/nu13010219 ◽

2021 ◽

Vol 13 (1) ◽

pp. 219

Author(s):

Sandro Giannini ◽

Giovanni Passeri ◽

Giovanni Tripepi ◽

Stefania Sella ◽

Maria Fusaro ◽

...

Keyword(s):

Vitamin D ◽

Characteristic Curve ◽

Area Under The Curve ◽

High Dose ◽

Current Cigarette Smoking ◽

Beneficial Effects ◽

Vitamin D Levels ◽

Comorbidity Burden ◽

Current Cigarette ◽

Comorbid Diseases

Little information is available on the beneficial effects of cholecalciferol treatment in comorbid patients hospitalized for COVID-19. The aim of this study was to retrospectively examine the clinical outcome of patients receiving in-hospital high-dose bolus cholecalciferol. Patients with a positive diagnosis of SARS-CoV-2 and overt COVID-19, hospitalized from 15 March to 20 April 2020, were considered. Based on clinical characteristics, they were supplemented (or not) with 400,000 IU bolus oral cholecalciferol (200,000 IU administered in two consecutive days) and the composite outcome (transfer to intensive care unit; ICU and/or death) was recorded. Ninety-one patients (aged 74 ± 13 years) with COVID-19 were included in this retrospective study. Fifty (54.9%) patients presented with two or more comorbid diseases. Based on the decision of the referring physician, 36 (39.6%) patients were treated with vitamin D. Receiver operating characteristic curve analysis revealed a significant predictive power of the four variables: (a) low (<50 nmol/L) 25(OH) vitamin D levels, (b) current cigarette smoking, (c) elevated D-dimer levels (d) and the presence of comorbid diseases, to explain the decision to administer vitamin D (area under the curve = 0.77, 95% CI: 0.67–0.87, p < 0.0001). Over the follow-up period (14 ± 10 days), 27 (29.7%) patients were transferred to the ICU and 22 (24.2%) died (16 prior to ICU and six in ICU). Overall, 43 (47.3%) patients experienced the combined endpoint of transfer to ICU and/or death. Logistic regression analyses revealed that the comorbidity burden significantly modified the effect of vitamin D treatment on the study outcome, both in crude (p = 0.033) and propensity score-adjusted analyses (p = 0.039), so the positive effect of high-dose cholecalciferol on the combined endpoint was significantly amplified with increasing comorbidity burden. This hypothesis-generating study warrants the formal evaluation (i.e., clinical trial) of the potential benefit that cholecalciferol can offer in these comorbid COVID-19 patients.

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Association of Vitamin D Status With Liver and Kidney Disease: A Systematic Review of Clinical Trials, and Cross-Sectional and Cohort Studies

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000540 ◽

2019 ◽

pp. 1-13 ◽

Cited By ~ 2

Author(s):

Seyed Mostafa Parizadeh ◽

Majid Rezayi ◽

Reza Jafarzadeh-Esfehani ◽

Amir Avan ◽

Hamideh Ghazizadeh ◽

...

Keyword(s):

Vitamin D ◽

Kidney Disease ◽

Renal Disease ◽

Cohort Studies ◽

Cochrane Library ◽

Major Public Health Problem ◽

Vitamin D Status ◽

Cross Sectional ◽

Beneficial Effects ◽

Vitamin D Levels

Abstract. Background: Vitamin D deficiency (VDD) is a major public health problem. There are few comprehensive systematic reviews about the relationship between Vitamin D status and liver and renal disease in Iran. Methods: We systemically searched the following databases: Web of Science; PubMed; Cochrane Library; Scopus; Science Direct; Google Scholar and two Iranian databases (Scientific Information Database (SID) and IranMedex) up until November 2017 to identify all randomized control trials (RCTs), case control, cross-sectional and cohort studies investigating the association between vitamin D and any form of liver or kidney disease. Results: Vitamin D insufficiency, or deficiency (VDD), is highly prevalent in Iran, reports varying between 44.4% in Isfahan to 98% in Gorgan. There is also a high prevalence of VDD among patients with liver or kidney disease, and the administration of vitamin D supplements may have beneficial effects on lipid profile, blood glucose, liver function and fatty liver disease, and bone health. Low serum vitamin D levels are related with abnormalities in these laboratory and clinical parameters. Conclusion: VDD is prevalent in patients with chronic liver or renal disease in Iran. There appear to be several beneficial effects of vitamin D supplementation in vitamin D deficient patients with liver or kidney disease.

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Vitamin D Deficiency as a Risk Factor for Myocardial Ischemia

Medicina ◽

10.3390/medicina57080774 ◽

2021 ◽

Vol 57 (8) ◽

pp. 774

Author(s):

Christina Batsi ◽

Evangelia Gkika ◽

Loukas Astrakas ◽

Athanassios Papadopoulos ◽

Ioannis Iakovou ◽

...

Keyword(s):

Vitamin D ◽

Risk Factor ◽

Myocardial Ischemia ◽

Single Photon ◽

Statistical Significance ◽

Photon Emission ◽

Serum Levels ◽

Emission Computed Tomography ◽

And Gender ◽

D Values

Background and Objectives: Vitamin D (Vit D) deficiency has been implicated in various conditions, including cardiovascular disease. The purpose of this retrospective study was to investigate the incidence of patients with myocardial ischemia in relation to their serum levels of vitamin D. Materials and Methods: A 64-month search (January 2016 to April 2021) in our database of the Nuclear Medicine Laboratory revealed 113 patients who had both myocardial perfusion imaging with single photon emission computed tomography (MPI SPECT) and Vit D measurements. MPI SPECT obtained myocardial images during both stress (summed stress score, SSS) and rest (summed rest score, SRS). Abnormal MPI SPECT was when the SSS was ≥4. Vit D was determined by radioimmunoassay (RIA). Patients with Vit D values <10 ng/mL, 10–29 ng/mL and ≥30 ng/mL were defined as having a deficiency, insufficiency and sufficiency, respectively. Results: Among patients, 46/113 (40.7%) were male and 67/113 (59.3%) were female. Abnormal MPI was found in 58/113 (51.3%) patients. Vit D deficiency was noted in 20/113 (17.7%) patients, insufficiency in 86/113 (76.1%) patients, and normal Vit D was noted in only 7/113 (6.2%) patients. Sixteen of the 20 patients (80%) with Vit D deficiency, and 38/86 (44.2%) with insufficiency had an abnormal MPI SPECT. In contrast, only 1/7 (14.3%) patients with sufficient Vit D levels had an abnormal MPI SPECT. The Mann-Whitney U-test showed that ischemia reduced the values of Vit D. Correlation analysis showed a negative association of Vit D levels with SSS (rho = −0.232, p = 0.014) and SRS (rho = −0.250, p = 0.008). Further evaluation with a Vit D cut off 20 ng/mL retrieved no statistical significance. Finally, Vit D and gender were independently associated with myocardial ischemia. Conclusions: Low Vit D levels may represent a risk factor for myocardial ischemia.

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Vitamin D Levels, APOE Allele, and MRI Volumetry Assessed by NeuroQuant in Norwegian Adults with Cognitive Symptoms

Journal of Alzheimer s Disease ◽

10.3233/jad-201018 ◽

2021 ◽

Vol 79 (1) ◽

pp. 311-321

Author(s):

Jelena Zugic Soares ◽

Renate Pettersen ◽

Jūratė Šaltytė Benth ◽

Karin Persson ◽

Carsten Strobel ◽

...

Keyword(s):

Vitamin D ◽

Late Onset ◽

Apoe Genotype ◽

Serum Levels ◽

Grey Matter Volume ◽

Cognitive Symptoms ◽

Cross Sectional ◽

Brain Volumes ◽

Vitamin D Levels ◽

Mri Volumetry

Background: Allele ɛ4 of the apolipoprotein (APOE ∈4) gene is the strongest known genetic risk factor for late-onset sporadic Alzheimer’s disease. A possible relationship between vitamin D and APOE is not yet clear. Objective: In this exploratory, cross-sectional study, we examined the association between serum levels of 25-hydroxyvitamin D [25(OH)D] and brain volumes and the associations of both serum levels of 25(OH)D and APOE polymorphism to brain volumes in 127 persons (mean age 66 years) with cognitive symptoms. Methods: All subjects were examined with fully automated software for MRI volumetry, NeuroQuant. Results: After adjustment for relevant covariates, higher serum 25(OH)D levels were associated with greater volumes of cortical gray matter on both left (p = 0.02) and right (p = 0.04) sides. When both 25(OH)D levels and APOE genotype were used as the main covariates, no significant associations were found between vitamin D level and brain volume in any of the 11 brain regions. In adjusted models, only homozygous but not heterozygous APOE ∈4 allele carriers had significantly larger inferior lateral ventricles (p = 0.003) and smaller hippocampal volume (p = 0.035) than those without ɛ4. Homozygous APOE ∈4 carriers also had significantly higher vitamin D levels (p = 0.009) compared to persons without the APOE ∈4 allele. Conclusion: Higher vitamin D levels might have a preserving effect on cortical grey matter volume.

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Reduction in circulating vitamin D binding protein in patients with multiple sclerosis

BMC Neurology ◽

10.1186/s12883-021-02200-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhila Maghbooli ◽

Abolfazl Omidifar ◽

Tarlan Varzandi ◽

Tayebeh Salehnezhad ◽

Mohammad Ali Sahraian

Keyword(s):

Multiple Sclerosis ◽

Vitamin D ◽

Binding Protein ◽

Serum Levels ◽

Causative Role ◽

Vitamin D Binding Protein ◽

Control Groups ◽

Current Case ◽

Vitamin D Levels ◽

And Control

Abstract Background In this study, we aimed to determine the risk association between vitamin D binding protein (VDBP) polymorphism in patients with multiple sclerosis (MS) in a MS biobank and the difference in VDBP serum levels in MS patients who were recently diagnosed. Method The current case-control study was performed on 296 MS patients and 313 controls. Thereafter, two common missense VDBP polymorphisms, named rs7041and rs4588, were evaluated in all the participants. Serum levels of vitamin D and vitamin D binding protein were assessed in 77 MS patients who were diagnosed since one year ago and in 67 healthy people who were matched in terms of age and sex. Result The frequency distributions of VDBP genotypes and alleles of SNP rs7041 and rs4588 were observed to be similar in both the MS and control groups (p > 0.05). The VDBP haplotypes, as Gc2/Gc2, Gc1/Gc1, and Gc1/Gc2, were found to be similar in the MS and control groups (p > 0.05). In subgroup analysis, circulating VDBP was lower in MS patients (Ln-VDBP (μgr/ml): 3.64 ± 0.91 vs. 5.31 ± 0.77, p = 0.0001) even after adjusting for vitamin D levels, body mass index, and taking vitamin D supplement. There was no significant association between VDBP haplotypes and vitamin D levels in the two groups. Conclusion The present study suggested an association between lower levels of circulating VDBP and multiple sclerosis in newly diagnosed patients. However, the VDBP causative role in the development of MS is still unclear, so it needs more studies.

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Comparison of Antioxidant Status and Vitamin D Levels between Multiple Sclerosis Patients and Healthy Matched Subjects

Multiple Sclerosis International ◽

10.1155/2014/539854 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Ehsan Hejazi ◽

Reza Amani ◽

Naser SharafodinZadeh ◽

Bahman Cheraghian

Keyword(s):

Multiple Sclerosis ◽

Vitamin D ◽

Dietary Intake ◽

Antioxidant Status ◽

Sun Exposure ◽

Total Antioxidant Status ◽

Serum Levels ◽

Study Groups ◽

Vitamin D Levels ◽

Multiple Sclerosis Patients

Objective. The aim of the present study was to compare the serum levels of total antioxidant status (TAS) and 25(OH) D3 and dietary intake of multiple sclerosis (MS) patients with those of normal subjects.Method. Thirty-seven MS patients (31 women) and the same number of healthy matched controls were compared for their serum levels and dietary intake of 25(OH) D3 and TAS. Sun exposure and the intake of antioxidants and vitamin D rich foods were estimated through face-to-face interview and food frequency questionnaire.Results. Dietary intake of antioxidants and vitamin D rich foods, vitamin C, vitamin A, and folate was not significantly different between the two groups. There were also no significant differences in the mean levels of 25(OH) D3 and TAS between the study groups. Both groups had low serum levels of 25(OH) D3 and total antioxidants.Conclusion. No significant differences were detected in serum levels and dietary intake of vitamin D and antioxidants between MS patients and healthy controls. All subjects had low antioxidant status and vitamin D levels.

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No correlation was observed between vitamin D levels and disability of patients with multiple sclerosis between latitudes 18° and 30° South

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20160173 ◽

2017 ◽

Vol 75 (1) ◽

pp. 3-8 ◽

Cited By ~ 4

Author(s):

Yara Dadalti Fragoso ◽

Tarso Adoni ◽

Soniza Vieira Alves-Leon ◽

Samira L. Apostolos-Pereira ◽

Walter Oleschko Arruda ◽

...

Keyword(s):

Multiple Sclerosis ◽

Vitamin D ◽

Large Population ◽

Serum Vitamin ◽

Serum Levels ◽

Serum Vitamin D ◽

Control Subjects ◽

Vitamin D Levels ◽

The Mean ◽

25 Oh Vitamin D

ABSTRACT Objective: Vitamin D has taken center stage in research and treatment of multiple sclerosis (MS). The objective of the present study was to assess the serum vitamin D levels of a large population of patients with MS and controls living in a restricted tropical area. Methods: Data from 535 patients with MS and 350 control subjects were obtained from 14 cities around the Tropic of Capricorn. Results: The mean serum 25-OH vitamin D level was 26.07 ± 10.27 ng/mL for the control subjects, and 28.03 ± 12.19 ng/mL for patients with MS. No correlation was observed between vitamin D levels and the disability of patients over the disease duration. Conclusion: At least for the region around the Tropic of Capricorn, serum levels of vitamin D typically are within the range of 20 to 30 ng/mL for controls and patients with MS.

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Serum levels of 25(OH)D are not associated with venous thromboembolism in the elderly population

Thrombosis and Haemostasis ◽

10.1160/th15-02-0148 ◽

2016 ◽

Vol 115 (01) ◽

pp. 169-175 ◽

Cited By ~ 1

Author(s):

Aurélien Delluc ◽

Marie-Pierre Moineau ◽

Cécile Tromeur ◽

Maelenn Gouillou ◽

Karine Lacut ◽

...

Keyword(s):

Vitamin D ◽

Venous Thromboembolism ◽

Seasonal Variations ◽

Elderly Population ◽

Serum Levels ◽

The Elderly ◽

Vitamin D Status ◽

Increased Risk ◽

Vitamin D Levels ◽

Walking Capacity

SummaryThe prevalence of both vitamin D deficiency and venous thromboembolism (VTE) is important in the elderly. Previous studies have provided evidence for a possible association between vitamin D status and the risk of VTE. Thus, we aimed to investigate the association between vitamin D levels and VTE in the population aged 75 and over included in the EDITH case-control study. The association between vitamin D status and VTE was analysed. We also analysed the monthly and seasonal variations of VTE and vitamin D. Between May 2000 and December 2009, 340 elderly patients (mean age 81.5 years, 32 % men) with unprovoked VTE and their controls were included. The univariate and multivariate analysis found no significant association between serum levels of vitamin D and the risk of unprovoked VTE. In the unadjusted analysis, a higher BMI was statistically associated with an increased risk of VTE (OR 1.09; 95 % CI 1.05–1.13) whereas a better walking capacity and living at home were associated with a decreased rate of VTE: OR 0.57; 95 % CI 0.36–0.90 and 0.40; 95 % CI 0.25–0.66, respectively. Although not significant, more VTE events occurred during winter (p=0.09). No seasonal variations of vitamin D levels were found (p=0.11). In conclusion, in contrast with previous reports our findings suggest that vitamin D is not associated with VTE in the elderly population.

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