Excess Vitamin D

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Excess Vitamin D

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$Chapter 46 Hypervitaminosis nausea, headache, hepatomegaly, increased risk of osteoporotic fractures ▪ Teratogenic effects ▫ Can cause spontaneous fetal death, facial/cardiac malformations (e.g. microcephaly) DIAGNOSIS DIAGNOSTIC IMAGING Bone X-rays ▪ Weakness/damage ▪ Liver function tests (LFTs): mild elevation of liver enzymes ▫ Liver biopsy: enlarged hepatocytes, increased ﬁbrosis in chronic hypervitaminosis A TREATMENT OTHER INTERVENTIONS ▪ Discontinue consumption of vitamin A supplements/foods containing high levels of vitamin A, esp. containing natural vitamin A (e.g. kidney, liver, egg yolks) LAB RESULTS ▪ Most vitamin A stored in liver, circulating concentrations not always accurate indicator EXCESS VITAMIN D osms.it/excess-vitamin-d PATHOLOGY & CAUSES ▪ Toxicity caused by excessive amounts of vitamin D ▫ Vitamin D increases circulating levels of calcium ▫ Most often caused by excessive intake ▪ Maximum tolerable intake 100mg for children > nine years old, adults, pregnant/ lactating individuals; lower for younger children ▪ Main consequence is hypercalcemia SIGNS & SYMPTOMS ▪ Acute intoxication (often due to hypercalcemia) ▫ Confusion, excessive thirst, nausea, vomiting ▪ Chronic intoxication ▫ Bone demineralization, pain; nephrocalcinosis; kidney damage DIAGNOSIS LAB RESULTS ▪ Serum concentration of 25(OH)D > 150ng/ mL (374nmol/L) TREATMENT OTHER INTERVENTIONS ▪ Discontinue consumption of vitamin D supplements; restrict dietary intake of calcium, dairy products (milk, cheese, yogurt), almonds OSMOSIS.ORG 275$

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Excess Vitamin D

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A 29-year-old woman is brought to the emergency department by her partner for evaluation of progressive confusion. She also complains of nausea and vomiting for the past 24-hours. Past medical history is significant for asthma and a chronic cough for the past year. The patient has had 2 episodes of uveitis in the past 6 months treated with topical therapy. Current medications include vitamin supplementation and inhaled albuterol as needed. Family history is noncontributory. She does not use tobacco, alcohol, or illicit drugs. Temperature is 37.2 C (98.9 F), pulse is 98/min, respirations are 18/min and blood pressure is 100/60 mmHg. Physical examination shows dry mucous membranes and multiple tender pink-to-reddish nodules below the knee. Chest x-ray shows bilateral hilar lymphadenopathy. Laboratory studies are performed and shown below:

Laboratory value	Result
Serum chemistry
Sodium	132 mEq/L
Potassium	4.2 mEq/L
Chloride	95 mEq/L
Calcium	11.8 mg/dL
Creatinine	0.8 mg/dL
Blood urea nitrogen	20 mg/dL

Serum ACE levels are increased. HIV testing is negative. Which of the following serum substance levels is most likely to be increased in this patient?

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