Incidence And Risk Factors Of Osteoporotic Fracture In RA Patients: A Multicenter Study Of The Frax And Who Criteria

Case reportRecently some studies revealed that low vitamin D level is associated with increasing risk of type 1 diabetes mellitus, cardiovascular diseases, neurodegenerative diseases, and cancer.The importance of vitamin D is on the rise.Therefore, people have interest in using vitamin D supplements.However, overdose of vitamin D could cause serious adverse effects.This study shows a case of vitamin D overdose resulting hypercalcemia.There is no absolute reference of intake dose of vitamin D that can cause toxic result.Up to 10,000 IU daily has been considered safe in a healthy population.The Institute of Medicine recommended dose varies from 800 to 4,000IU per day according to age.Some case reports showed that hypercalcemia and acute kidney injury were due to overdose vitamin D. We report a case of a 36-year-old type 1 diabetic female with chronic kidney disease who took 50,000 IU of vitamin D3 (cholecalciferol) for 2 months.Initially, serum creatinine level was 2.65 mg/dL and eGFR was 20.37ml/ min/1.73m2(previous level 1.74 mg/dL, eGFR 33.11 ml/min/1.73m2).Serum total calcium level was 14 mg/dL (ionized calcium 7.32 mg/dL), and 25-hydroxy-vitamin D level was 319 ng/mL (in 1:5 dilution level, 63.8 ng/ mL).Hypercalcemia and acute kidney injury were managed by hydration (normal saline) and diuretics (furosemide), calcitonin, pamidronate.After appropriate treatment, serum calcium level was normalized (total calcium 10.6 mg/dL, ionized calcium 5.76 mg/dL) and serum creatinine levels decreased to 2.27 mg/dL.After education of taking vitamin D properly, the patient discharged without other complications.