From the Research
For vitamin D toxicity with a level of 290 ng/mL, immediate medical attention is needed, and levels should be rechecked weekly until they fall below 150 ng/mL, then monthly until they normalize (below 100 ng/mL). This severe toxicity requires stopping all vitamin D supplements immediately and possibly hospitalization for monitoring and treatment. Treatment typically includes IV fluids, corticosteroids, bisphosphonates, and calcitonin if hypercalcemia is present, as seen in a case report where peritoneal dialysis was used to manage severe hypercalcemia secondary to vitamin D toxicity 1. Dietary calcium should be restricted, and sun exposure minimized during recovery. The frequency of monitoring may be adjusted based on symptom improvement and the rate at which vitamin D levels decrease. Vitamin D toxicity at this level is serious as it can cause hypercalcemia leading to kidney damage, cardiac arrhythmias, and neurological symptoms, as reported in a study where the median time to resolution of hypercalcemia was 7 months 2. Recovery can take weeks to months since vitamin D is fat-soluble and stored in body tissues. It is essential to note that the determination of doses at which vitamin D becomes toxic remains elusive, but high doses can lead to toxicity, as seen in a case report where a patient took a cumulative dose of 78,000 UI of cholecalciferol over 20 months 3. In general, repeated measurements of vitamin D are not necessary for patients under standard integrative therapy, but patients and clinicians should be aware of the potential dangers of vitamin D overdose 3. The use of bisphosphonates, such as pamidronate, has been shown to be effective in treating hypercalcemia caused by vitamin D intoxication by reducing bone resorption 4.
Some key points to consider in managing vitamin D toxicity include:
- Stopping all vitamin D supplements immediately
- Hospitalization for monitoring and treatment if necessary
- Treatment with IV fluids, corticosteroids, bisphosphonates, and calcitonin if hypercalcemia is present
- Restricting dietary calcium and minimizing sun exposure during recovery
- Monitoring vitamin D levels weekly until they fall below 150 ng/mL, then monthly until they normalize
- Being aware of the potential dangers of vitamin D overdose and taking steps to prevent it.
It is crucial to prioritize the patient's morbidity, mortality, and quality of life when managing vitamin D toxicity, and to adjust the frequency of monitoring and treatment based on symptom improvement and the rate at which vitamin D levels decrease, as supported by the most recent and highest quality study 2.