Endocrine Abstracts

Introduction: Vitamin D is a fat soluble prohormone and can be produced in the body with adequate sunlight exposure or taken up by consumed foods or supplements. Recently vitamin D deficiency has been seen in pandemic. A rare disease, vitamin D intoxication is usually iatrogenic. High levels of 25(OH) vitamin D increases the intestinal calcium absorption and causes severe and refractory hypercalcemia. In this case report we presented a patient with pancreatitis and hypercalcemia secondary to vitamin D intoxication.

Case: 79-years-old female patient presented to emergency department with generalized pain, lack of appetite, dry mouth, nausea, vomiting and abdominal pain. Serum calcium level was 13.8 mg/dl. In her medical history she used 12 ampules of vitamin D-3 in the last month. In her physical examination there was abdominal tenderness. Laboratory findings were as follows; 25-OH vitamin D-3: 455 μg/l (20–150), WBC: 19 570 10e3/μl (3.8–8.6), Urea: 60 mg/dl (10–50), Creatinine: 2 mg/dl (0.6–1.2), Ca: 13.8 mg/dl (8.5–10.8), phosphorus: 2.9 mg/dl (2.6–4.5), albumin: 3.7 mg/dl (3.5–5.5), amylase: 132 U/l (28–100), Lipase: 115 U/l (7–60), Parathormone: 28 pg/ml (19.8–74.9). Abdominal CT scan showed interstitial oedematous pancreatitis. In the follow up, patient was hydrated with isotonic saline infusion. To lower the calcium levels, intravenous furosemide infusion was used. Calculated QTc level when serum calcium is 9.1 mg/dl, was 443 msec. According to literature we could see osborn wave in the ECG but we did not.

Discussion: Vitamin D toxicity develops when serum levels of 25 OH vitamin D-3 levels reach 150 ng/ml or above and daily intake should exceed 10.000 IU. In the treatment, cessation of vitamin D intake and controlling of hypercalcemia is mandatory. Limiting daily calcium intake, hydration, loop diuretics, corticosteroids, calcitonin and bisphosphonates can also be used. Dialysis can be performed to those who are refractory to these treatment modalities.

Conclusion: Uncontrolled and over the counter use of vitamin supplements is a common issue worldwide. Patients who need vitamin D supplements should be followed with laboratory and clinically.