A family with massive acute vitamin D intoxication

Area of Science:

• Endocrinology
• Toxicology
• Nutritional Science

Background:

• Vitamin D is essential for calcium absorption and bone health.
• Excessive vitamin D intake can lead to toxicity, characterized by hypercalcemia.
• Accidental massive overdosage of vitamin D is rare but can have severe health consequences.

Observation:

• A family ingested food contaminated with nut oil containing 5 million units of vitamin D3/ml.
• Elevated plasma vitamin D levels were observed in all family members, significantly exceeding the normal range.
• Symptoms of hypercalcemia were present in all affected individuals.

Findings:

• The infant responded to prednisone treatment, while parents required neutral phosphate therapy for 9 months to manage hypercalcemia.
• Negative calcium balance indicated that vitamin D toxicity mobilized calcium from bone.
• Renal biopsy revealed persistent nephrocalcinosis in one patient 11 years post-exposure.

Implications:

• This case highlights the potential dangers of extreme vitamin D overdosage.
• Effective management strategies for vitamin D toxicity include corticosteroids and phosphate therapy.
• Long-term monitoring is crucial to detect and manage chronic complications like nephrocalcinosis.