Vitamin D intoxication presenting as acute renal failure.

Area of Science:

• Nephrology
• Endocrinology
• Public Health

Background:

• Vitamin D deficiency is prevalent globally, particularly in regions with limited sunlight exposure.
• Sunlight exposure is crucial for endogenous vitamin D synthesis.
• Vitamin D supplementation is common to address deficiency.

Observation:

• A 70-year-old male presented with acute renal failure and mental obtundation.
• Examination revealed hypercalcemia.
• The patient reported recent injections of a slow-release vitamin D preparation.

Findings:

• The patient's hypercalcemia and acute renal failure were directly linked to vitamin D intoxication from excessive supplementation.
• This case highlights the risk of vitamin D toxicity even in a population with near-universal deficiency (100% in the Kashmir valley).
• The deficiency is attributed to indoor confinement and lack of sunlight exposure.

Implications:

• Clinicians should consider vitamin D toxicity in patients with unexplained hypercalcemia and renal failure, especially those undergoing supplementation.
• Careful monitoring of vitamin D levels is essential during supplementation, even in deficient populations.
• Public health strategies may need to balance addressing deficiency with preventing toxicity.