From the Guidelines
Taking more vitamin D is not recommended for someone with hypercalcemia, as it can worsen the condition by increasing calcium absorption in the intestines. According to the 2017 KDIGO CKD-MBD guideline update published in Kidney International 1, in patients with hypercalcemia, it is recommended to reduce or stop calcitriol or another vitamin D sterol (1B). This is because vitamin D helps the body absorb calcium, and increasing vitamin D intake when calcium is already elevated can further increase calcium levels in the blood.
Key Considerations
- Hypercalcemia can be caused by various factors, including hyperparathyroidism, certain cancers, medications, or excessive vitamin D supplementation itself.
- Treatment typically focuses on addressing the root cause rather than adjusting vitamin D intake.
- Reducing calcium and vitamin D supplements, increasing fluid intake, and possibly medications like bisphosphonates or calcitonin may be recommended to lower calcium levels.
- High calcium can cause symptoms like fatigue, bone pain, kidney stones, and cognitive issues, and can be dangerous if left untreated, so professional medical evaluation is essential rather than self-adjusting supplements.
Clinical Implications
- Patients with hypercalcemia should consult their healthcare provider to determine the underlying cause and develop an appropriate treatment plan.
- The 2017 KDIGO CKD-MBD guideline update provides evidence-based recommendations for managing hypercalcemia, including reducing or stopping vitamin D sterols in patients with hypercalcemia 1.
- Clinicians should prioritize reducing calcium and vitamin D supplements, and consider medications to lower calcium levels, rather than increasing vitamin D intake, to manage hypercalcemia effectively.
From the Research
Hypercalcemia and Vitamin D
- Hypercalcemia is a condition characterized by elevated calcium levels in the blood, which can be caused by various factors, including primary hyperparathyroidism, malignancy, and excessive intake of vitamin D or calcium supplements 2.
- Vitamin D supplements can increase intestinal calcium absorption, renal calcium reabsorption, and bone resorption, leading to hypercalcemia 3.
- A case study reported a rare instance of persistent symptomatic hypervitaminosis D-induced hypercalcemia in an individual taking 50,000 IU of vitamin D supplement daily, which was treated with glucocorticoids and bisphosphonates 4.
Treatment of Hypercalcemia
- The treatment of hypercalcemia depends on the underlying cause and severity of the condition, and may involve hydration, intravenous bisphosphonates, glucocorticoids, and other medications 2, 4, 5.
- In patients with hypercalcemia due to vitamin D intoxication, glucocorticoids may be used as primary treatment to reduce serum calcium levels and improve symptoms 2, 4.
- Bisphosphonates, such as zoledronic acid or pamidronate, are commonly used to treat hypercalcemia, especially in patients with malignancy-related hypercalcemia 2, 5.
Vitamin D Supplementation and Hypercalcemia
- A study found that cholecalciferol supplementation in critically ill patients with vitamin D deficiency was associated with a substantial proportion of patients developing hypercalcemia without hypervitaminosis D 6.
- Another study reported that vitamin D supplements can cause hypercalcemia, especially in patients with hypoparathyroidism or those taking high doses of vitamin D 3.
- It is essential to monitor serum calcium levels and adjust vitamin D supplementation accordingly to avoid hypercalcemia 6, 3.