Introduction: 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. Case description: 16 year old male, previously healthy, presented with 2-week history of non specific symptoms (fatigue, gastrointestinal complaints). Investigations showed acute kidney injury and hypercalcemia (total calcium 3.81 mmol/L). Further diagnostic workup revealed markedly elevated 25-hydroxy-vitamin D levels (1910 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 IV 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: 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; their use should be incorporated in anamnesis and considered a potential source of toxicity when an alternative source cannot be found, regardless of the product label.


中文翻译：

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不寻常和意外来源的维生素 D 毒性：2 例报告

简介：维生素 D 过多症是一种相对少见的高钙血症病因。毒性通常是由非常高的剂量引起的，主要是继发于错误的处方或维生素 D 的给药，不太常见的是受污染的食物或含维生素 D 的补充剂的制造错误。病例描述：16 岁男性，既往健康，有 2 周的非特异性症状史（疲劳、胃肠道不适）。调查显示急性肾损伤和高钙血症（总钙 3.81 毫摩尔/升）。进一步的诊断检查显示 25-羟基维生素 D 水平显着升高 (1910 nmol/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维生素 D 含量为 425，每份 000 IU（每日可耐受剂量上限的 100 倍）。几个月后，另一名以前健康的青少年出现严重的高钙血症和继发于维生素 D 过多症的急性肾损伤。他还使用了来自同一制造商品牌和批次的肌酸补充剂。两名患者均接受了静脉补液、降钙素和帕米膦酸盐治疗。他们在初次就诊后维持正常钙血症，但在此次暴露后数月需要低钙饮食和实验室检测。讨论：我们介绍了 2 例由未声称含有维生素 D 的天然保健品制造错误引起的维生素 D 过多症。膳食补充剂的使用非常普遍；