From the Guidelines
A vitamin D level of 86 ng/mL is elevated but typically not high enough to cause vitamin D toxicity or hypercalcemia in most individuals, and symptoms of hypercalcemia may include polyuria, polydipsia, nausea, confusion, vomiting, abdominal pain, and myalgia, as seen in patients with lung cancer 1.
Symptoms of Hypercalcemia
The symptoms of hypercalcemia depend on the severity and acuity of onset, and may include:
- Polyuria
- Polydipsia
- Nausea
- Confusion
- Vomiting
- Abdominal pain
- Myalgia In severe cases, hypercalcemia can lead to mental status changes, bradycardia, and hypotension 1.
Management of Hypercalcemia
The management of hypercalcemia includes oral hydration, rehydrating with IV crystalloid fluids, and giving loop diuretics as needed, as well as bisphosphonates, glucocorticoids, gallium nitrate, and salmon calcitonin 1.
Vitamin D Toxicity
Vitamin D toxicity generally occurs at levels above 100-150 ng/mL, and the 25(OH)D level associated with toxicity is often defined as >500 nmol/L [>200 ng/mL] 1.
Recommendations
If you have a vitamin D level of 86 ng/mL, you should discontinue vitamin D supplements unless directed otherwise by your healthcare provider, and monitoring calcium levels would be appropriate, as well as staying well-hydrated to help protect kidney function 1. An upper safety limit of 100 ng/mL has been proposed, and most international authorities consider a vitamin D intake of 2,000 IU daily as absolutely safe 1. However, it is essential to note that the body cannot effectively regulate vitamin D that comes from supplements as it does with vitamin D produced from sun exposure, which is why supplementation can potentially lead to toxicity while natural production rarely does.
From the Research
Symptoms of Vitamin D Toxicity
The symptoms of vitamin D toxicity with a level of 86 ng/mL, specifically hypercalcemia, include:
- Confusion, apathy, recurrent vomiting, abdominal pain, polyuria, polydipsia, and dehydration 2
- Nausea, vomiting, dehydration, confusion, somnolence, and coma in cases of severe hypercalcemia 3
- Constitutional symptoms such as fatigue and constipation in approximately 20% of people with mild hypercalcemia 3
Hypercalcemia Causes and Treatment
Hypercalcemia can be caused by:
- Excessive long-term intake of vitamin D, malfunctions of the vitamin D metabolic pathway, or the existence of coincident disease that produces the active vitamin D metabolite locally 2
- Primary hyperparathyroidism (PHPT) or malignancy, which account for approximately 90% of hypercalcemia cases 3
- Granulomatous disease, endocrinopathies, immobilization, genetic disorders, and medications such as thiazide diuretics and supplements like calcium, vitamin D, or vitamin A 3 Treatment for hypercalcemia typically involves:
- Hydration and intravenous bisphosphonates, such as zoledronic acid or pamidronate, for symptomatic or severe hypercalcemia 3
- Glucocorticoids as primary treatment when hypercalcemia is due to excessive intestinal calcium absorption (vitamin D intoxication, granulomatous disorders, some lymphomas) 3, 4
Vitamin D Toxicity Diagnosis and Prevention
Vitamin D toxicity can be diagnosed by:
- Laboratory testing for serum 25-hydroxyvitamin D [25(OH)D] concentrations, which should be higher than 150 ng/ml (375 nmol/l) to indicate vitamin D toxicity 2
- Identifying the underlying cause of hypercalcemia and treating it accordingly 3 Prevention of vitamin D toxicity involves:
- Avoiding excessive intake of vitamin D supplements and being aware of the risks of self-administration of high doses of vitamin D 2
- Monitoring serum calcium and 25(OH)D levels regularly, especially in individuals taking vitamin D supplements 2, 5