Khan Umar H, Mantoo Suhail, Dhar Amrit, Shabir Afshan, Shah Asma, Mehfooz Nazia, Shah Sonaullah
Internal and Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND.
Cureus. 2022 Dec 18;14(12):e32654. doi: 10.7759/cureus.32654. eCollection 2022 Dec.
Background and objective Around 25-30% of elderly patients present to emergency departments (ED) with altered mental status (AMS), with hypercalcemia being one of the metabolic causes. Elderly patients, due to their multiple vulnerability factors and relative homeostenosis, are susceptible to alterations in mental state at even milder grades of hypercalcemia. There is a trend of overzealous prescription of higher doses of vitamin D in elderly patients for various ailments, which often exceeds the requirements of the patients. In this study, we aimed to establish vitamin D toxicity (VDT) as an underlying cause of AMS in elderly patients presenting to the hospital. Methods This was a descriptive case study conducted at a tertiary care university hospital in North India, from January 2015 to March 2020 for a total duration of five years. Elderly patients (aged ≥60 years) who were admitted with VDT as a cause for underlying hypercalcemia were included. The evaluation included patient history regarding the dosage of vitamin D received, route of administration, and biochemical parameters, such as serum calcium, intact parathyroid hormone (iPTH), 25-hydroxy vitamin D [25(OH)D], and albumin. All other potential causes for hypercalcemia and AMS were ruled out concurrently. Results A total of 19 patients were enrolled in the study, with a mean age of 72.3 years (range: 62-86 years). All patients had received injectable vitamin D formulation. The mean serum calcium among the patients was 12.52 ± 1.12 mg/dL (range: 11.2-15.7 mg/dL), whereas the mean 25(OH)D was 196.34 ± 70.44 ng/mL (range: 107-356 ng/mL). The mean cumulative vitamin D supplement intake was 2.594 ± 0.841 million IU (range: 1.2 million-4.2 million IU). While six patients had mild hypercalcemia, 12 had moderate, and one person had severe hypercalcemia, with altered sensorium (85%) being the most common complaint for presenting to ED, followed by generalized weakness (15%). Conclusion VDT can manifest with AMS as an initial presenting complaint. The geriatric population, due to various underlying vulnerability factors, is more susceptible than their younger counterparts. We strongly recommend that in elderly patients, higher doses of vitamin D should be prescribed only after checking their serum levels, and frequent monitoring of vitamin D should be performed.
约25%-30%的老年患者因精神状态改变（AMS）就诊于急诊科，高钙血症是代谢性病因之一。老年患者由于存在多种脆弱因素及相对内环境稳定，即使在轻度高钙血症时也易出现精神状态改变。老年患者因各种疾病过度热心地开具高剂量维生素D的趋势普遍存在，且常常超过患者的需求。在本研究中，我们旨在确定维生素D毒性（VDT）是老年患者入院时AMS的潜在病因。方法：这是一项描述性病例研究，于2015年1月至2020年3月在印度北部一家三级护理大学医院进行，为期五年。纳入因VDT导致潜在高钙血症而入院的老年患者（年龄≥60岁）。评估包括患者接受维生素D的剂量、给药途径以及生化参数，如血清钙、完整甲状旁腺激素（iPTH）、25-羟维生素D[25(OH)D]和白蛋白。同时排除高钙血症和AMS的所有其他潜在病因。结果：共19例患者纳入研究，平均年龄72.3岁（范围：62-86岁）。所有患者均接受了注射用维生素D制剂。患者的平均血清钙为12.52±1.12mg/dL（范围：11.2-15.7mg/dL），而平均25(OH)D为196.34±70.44ng/mL（范围：107-356ng/mL）。维生素D补充剂的平均累积摄入量为259.4±84.1万IU（范围：120万-420万IU）。6例患者为轻度高钙血症，12例为中度，1例为重度高钙血症，意识改变（85%）是就诊于急诊科最常见的主诉，其次是全身无力（15%）。结论：VDT可表现为以AMS作为初始就诊主诉。老年人群由于各种潜在脆弱因素，比年轻人群更易患病。我们强烈建议，对于老年患者，仅在检查其血清水平后才应开具高剂量维生素D，并应定期监测维生素D。
