Division of Endocrinology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Horm Res Paediatr. 2023;96(3):332-340. doi: 10.1159/000526755. Epub 2022 Aug 26.
Hypervitaminosis D is a relatively uncommon etiology of hypercalcemia. Toxicity is usually caused by very high doses, mostly secondary to erroneous prescription or administration of vitamin D, and less commonly, contaminated foods or manufacturing errors of vitamin D-containing supplements.
A 16-year-old male, previously healthy, presented with 2-week history of nonspecific symptoms (fatigue, gastrointestinal complaints). Investigations showed acute kidney injury and hypercalcemia (total calcium 3.81 mmol/L). Further diagnostic workup revealed markedly elevated 25-hydroxyvitamin D levels (1,910 nmol/L). He denied taking any vitamin D supplements; however, he reported consumption of creatine and protein supplements. Mass spectrometry analysis of the creatine supplement estimated a vitamin D content of 425,000 IU per serving (100 times the upper tolerable daily dose). A few months later, another previously healthy adolescent presented with severe hypercalcemia and acute kidney injury secondary to hypervitaminosis D. He was also using a creatine supplement, from the same manufacturer brand and lot. Both patients were treated with intravenous hydration, calcitonin, and pamidronate. They maintained normocalcemia after their initial presentation but required low-calcium diets and laboratory testing for months after this exposure.
DISCUSSION/CONCLUSION: We present 2 cases of hypervitaminosis D caused by a manufacturing error of a natural health product which did not claim to contain vitamin D. The use of dietary supplements is highly prevalent; this should be incorporated while taking medical history, and considered a potential source of toxicity when an alternative source cannot be found, regardless of the product label.
维生素 D 过多症是一种相对罕见的高钙血症病因。毒性通常是由非常高的剂量引起的，主要是由于维生素 D 的错误处方或给药，以及较少见的污染食物或含有维生素 D 的补充剂的制造错误。
一名 16 岁男性，既往健康，出现 2 周非特异性症状（疲劳、胃肠道不适）。检查发现急性肾损伤和高钙血症（总钙 3.81mmol/L）。进一步的诊断工作显示 25-羟维生素 D 水平显著升高（1910nmol/L）。他否认服用任何维生素 D 补充剂；然而，他报告说服用了肌酸和蛋白质补充剂。肌酸补充剂的质谱分析估计每份含有 425000IU 的维生素 D（是最高耐受日剂量的 100 倍）。几个月后，另一名以前健康的青少年因维生素 D 过多症引起的严重高钙血症和急性肾损伤而就诊。他也在使用同一家制造商的肌酸补充剂。这两例患者均接受静脉补液、降钙素和帕米膦酸治疗。他们在初始表现后维持正常血钙，但在此暴露后需要低钙饮食和实验室检测数月。
讨论/结论：我们报告了 2 例由天然保健品制造错误引起的维生素 D 过多症病例，这些保健品并未声称含有维生素 D。膳食补充剂的使用非常普遍；在采集病史时应将其纳入考虑，并且在无法找到其他来源时，应考虑其作为毒性的潜在来源，无论产品标签如何。
