Vitamin D Toxicity Managed with Peritoneal Dialysis
Vitamin D deficiency is a global health issue that afflicts more than one billion children and adults worldwide. Vitamin D supplementation has increased over the years, whether through medical prescriptions, over-the-counter, or online purchasing. This is driven by a more recognized association betw...
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| Format: | Article |
| Language: | English |
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Wiley
2021-01-01
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| Series: | Case Reports in Endocrinology |
| Online Access: | http://dx.doi.org/10.1155/2021/9912068 |
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| author | Krystel Feghali Kostas Papamarkakis Jackson Clark Neha Malhotra Lanu Stoddart Ibitoro Osakwe |
| author_facet | Krystel Feghali Kostas Papamarkakis Jackson Clark Neha Malhotra Lanu Stoddart Ibitoro Osakwe |
| author_sort | Krystel Feghali |
| collection | DOAJ |
| description | Vitamin D deficiency is a global health issue that afflicts more than one billion children and adults worldwide. Vitamin D supplementation has increased over the years, whether through medical prescriptions, over-the-counter, or online purchasing. This is driven by a more recognized association between vitamin D sufficiency status and lower risk of cancer. In addition, more recently, it is used as a potential prophylactic and treatment for COVID-19 infection. This can lead to toxicity from overingestion. While rare, it has been reported in the literature. In this case report, we present a 75-year-old man with severe hypercalcemia secondary to vitamin D toxicity managed with peritoneal dialysis. He presented with biochemical evidence of hypercalcemia, acute kidney injury, and pancreatitis. Workup for his hypercalcemia led to the diagnosis of vitamin D toxicity as shown by a level greater than 200 ng/dL (Ref: 20–50 ng/mL) was confirmed by liquid chromatography-mass spectroscopy. Cornerstone medical management of hypercalcemia was provided which included aggressive intravenous fluid hydration, intravenous diuretics, calcitonin, bisphosphonate, and corticosteroid therapy. At every interruption of therapy, calcium levels trended upward. A thorough literature review yielded the finding of a sole case report from 1966 presented at the Third International Congress of Nephrology, in which peritoneal dialysis was used in the management of vitamin D toxicity and hypercalcemia. This modality is established to cause vitamin D deficiency. In collaboration with the nephrology team, 10 sessions of peritoneal dialysis were undertaken with resolution of hypercalcemia and downtrend in 25-hydroxyvitamin D levels as measured by dilution. |
| format | Article |
| id | doaj-art-a36b94296ed04476bc9e55fdd651d637 |
| institution | Kabale University |
| issn | 2090-6501 2090-651X |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Endocrinology |
| spelling | doaj-art-a36b94296ed04476bc9e55fdd651d6372025-02-03T07:24:02ZengWileyCase Reports in Endocrinology2090-65012090-651X2021-01-01202110.1155/2021/99120689912068Vitamin D Toxicity Managed with Peritoneal DialysisKrystel Feghali0Kostas Papamarkakis1Jackson Clark2Neha Malhotra3Lanu Stoddart4Ibitoro Osakwe5Department of Endocrinology, Diabetes and Metabolism, University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA, USADivision of Nephrology, University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA, USADivision of Internal Medicine, University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA, USADepartment of Endocrinology, Diabetes and Metabolism, University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA, USADivision of Pathology, University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA, USADepartment of Endocrinology, Diabetes and Metabolism, University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA, USAVitamin D deficiency is a global health issue that afflicts more than one billion children and adults worldwide. Vitamin D supplementation has increased over the years, whether through medical prescriptions, over-the-counter, or online purchasing. This is driven by a more recognized association between vitamin D sufficiency status and lower risk of cancer. In addition, more recently, it is used as a potential prophylactic and treatment for COVID-19 infection. This can lead to toxicity from overingestion. While rare, it has been reported in the literature. In this case report, we present a 75-year-old man with severe hypercalcemia secondary to vitamin D toxicity managed with peritoneal dialysis. He presented with biochemical evidence of hypercalcemia, acute kidney injury, and pancreatitis. Workup for his hypercalcemia led to the diagnosis of vitamin D toxicity as shown by a level greater than 200 ng/dL (Ref: 20–50 ng/mL) was confirmed by liquid chromatography-mass spectroscopy. Cornerstone medical management of hypercalcemia was provided which included aggressive intravenous fluid hydration, intravenous diuretics, calcitonin, bisphosphonate, and corticosteroid therapy. At every interruption of therapy, calcium levels trended upward. A thorough literature review yielded the finding of a sole case report from 1966 presented at the Third International Congress of Nephrology, in which peritoneal dialysis was used in the management of vitamin D toxicity and hypercalcemia. This modality is established to cause vitamin D deficiency. In collaboration with the nephrology team, 10 sessions of peritoneal dialysis were undertaken with resolution of hypercalcemia and downtrend in 25-hydroxyvitamin D levels as measured by dilution.http://dx.doi.org/10.1155/2021/9912068 |
| spellingShingle | Krystel Feghali Kostas Papamarkakis Jackson Clark Neha Malhotra Lanu Stoddart Ibitoro Osakwe Vitamin D Toxicity Managed with Peritoneal Dialysis Case Reports in Endocrinology |
| title | Vitamin D Toxicity Managed with Peritoneal Dialysis |
| title_full | Vitamin D Toxicity Managed with Peritoneal Dialysis |
| title_fullStr | Vitamin D Toxicity Managed with Peritoneal Dialysis |
| title_full_unstemmed | Vitamin D Toxicity Managed with Peritoneal Dialysis |
| title_short | Vitamin D Toxicity Managed with Peritoneal Dialysis |
| title_sort | vitamin d toxicity managed with peritoneal dialysis |
| url | http://dx.doi.org/10.1155/2021/9912068 |
| work_keys_str_mv | AT krystelfeghali vitamindtoxicitymanagedwithperitonealdialysis AT kostaspapamarkakis vitamindtoxicitymanagedwithperitonealdialysis AT jacksonclark vitamindtoxicitymanagedwithperitonealdialysis AT nehamalhotra vitamindtoxicitymanagedwithperitonealdialysis AT lanustoddart vitamindtoxicitymanagedwithperitonealdialysis AT ibitoroosakwe vitamindtoxicitymanagedwithperitonealdialysis |