Division of Endocrinology, Beth Israel Medical Center, 317 East 17th Street, New York, New York 10003, USA.
J Clin Endocrinol Metab. 2011 Dec;96(12):3603-8. doi: 10.1210/jc.2011-1443. Epub 2011 Sep 14.
More than 50% of Americans use dietary supplements, and 60-70% fail to report this use to their physicians. Intoxication from vitamin D supplements has been rarely reported but may now occur more frequently. This may be attributable to an increase in vitamin D supplement intake due to the findings that deficiency is common and has been associated with a number of disease states.
We report two cases of vitamin D intoxication with dietary supplements made in the United States caused by manufacturing and labeling errors.
Case histories were obtained, and serial laboratory data (calcium and vitamin D metabolites) were measured. Each dietary supplement was analyzed by UV spectrophotometry followed by HPLC.
In both cases, repetitive inquiries were required to elicit the use of dietary supplements. Because of significant manufacturer errors and a labeling error, patients had been consuming more than 1000 times the recommended daily dose of vitamin D(3). Hypercalcemia is directly proportional to serum 25-hydroxyvitamin D [25(OH)D] but not 1,25-dihydroxyvitamin D levels. It took approximately 1 yr to normalize 25(OH)D levels. However, once 25(OH)D levels decreased below 400 ng/ml, both patients became normocalcemic and asymptomatic without long-term sequelae.
Although rare, vitamin D intoxication should be considered in the differential diagnosis of hypercalcemia. Patients should be asked whether they are using dietary supplements, and serial questioning may be required because patients may not consider these supplements to be potential health risks. Errors in the manufacturing and labeling of dietary supplements made in the United States may place individuals at increased risks for side effects.
超过 50%的美国人使用膳食补充剂，但 60-70%的人没有向医生报告这些使用情况。维生素 D 补充剂中毒的报道很少见，但现在可能更常见。这可能是由于维生素 D 补充剂摄入量的增加，因为研究发现缺乏症很常见，并与许多疾病状态有关。
我们报告了两起因制造和标签错误导致的美国产膳食补充剂维生素 D 中毒病例。
获取病历，并测量了一系列实验室数据（钙和维生素 D 代谢物）。每个膳食补充剂都通过紫外分光光度法进行分析，然后通过 HPLC 进行分析。
在这两例中，需要反复询问才能了解膳食补充剂的使用情况。由于制造商的重大错误和标签错误，患者摄入的维生素 D(3)超过推荐日剂量的 1000 倍以上。高钙血症与血清 25-羟维生素 D [25(OH)D]直接相关，但与 1,25-二羟维生素 D 水平无关。大约需要 1 年时间才能使 25(OH)D 水平正常化。然而，一旦 25(OH)D 水平降至 400ng/ml 以下，两名患者均恢复正常血钙水平且无症状，无长期后遗症。
尽管罕见，但在高钙血症的鉴别诊断中应考虑维生素 D 中毒。应询问患者是否使用膳食补充剂，并且可能需要反复询问，因为患者可能不认为这些补充剂是潜在的健康风险。美国制造的膳食补充剂在制造和标签上的错误可能会使个人面临更高的副作用风险。
