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Wang D, Chen Y, Li J, Wu E, Tang T, Singla RK, Shen B, Zhang M. Natural products for the treatment of age-related macular degeneration. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 130:155522. [PMID: 38820665 DOI: 10.1016/j.phymed.2024.155522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 02/08/2024] [Accepted: 03/07/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Age-related macular degeneration (AMD) is a chronic retinal disease that significantly influences the vision of the elderly. PURPOSE There is no effective treatment and prevention method. The pathogenic process behind AMD is complex, including oxidative stress, inflammation, and neovascularization. It has been demonstrated that several natural products can be used to manage AMD, but systematic summaries are lacking. STUDY DESIGN AND METHODS PubMed, Web of Science, and ClinicalTrials.gov were searched using the keywords "Biological Products" AND "Macular Degeneration" for studies published within the last decade until May 2023 to summarize the latest findings on the prevention and treatment of age-related macular degeneration through the herbal medicines and functional foods. RESULTS The eligible studies were screened, and the relevant information about the therapeutic action and mechanism of natural products used to treat AMD was extracted. Our findings demonstrate that natural substances, including retinol, phenols, and other natural products, prevent the development of new blood vessels and protect the retina from oxidative stress in cells and animal models. However, they have barely been examined in clinical studies. CONCLUSION Natural products could be highly prospective candidate drugs used to treat AMD, and further preclinical and clinical research is required to validate it to control the disease.
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Affiliation(s)
- Dongyue Wang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Yi Chen
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Jiakun Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China; Joint Laboratory of Artificial Intelligence for Critical Care Medicine, Department of Critical Care Medicine and Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, PR China
| | - Erman Wu
- Joint Laboratory of Artificial Intelligence for Critical Care Medicine, Department of Critical Care Medicine and Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, PR China
| | - Tong Tang
- Joint Laboratory of Artificial Intelligence for Critical Care Medicine, Department of Critical Care Medicine and Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, PR China
| | - Rajeev K Singla
- Joint Laboratory of Artificial Intelligence for Critical Care Medicine, Department of Critical Care Medicine and Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, PR China; School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab-144411, India.
| | - Bairong Shen
- Joint Laboratory of Artificial Intelligence for Critical Care Medicine, Department of Critical Care Medicine and Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, PR China.
| | - Ming Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
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Aljehani F, Qashqari MB, Alghamdi MK, Saadi AI, Alreasini MY, Alsolami E, Alfawaz M. Prevalence of Iatrogenic Vitamin D Toxicity Among the Saudi Population of Vitamin D Users Due to Overcorrection. Cureus 2023; 15:e37521. [PMID: 37193464 PMCID: PMC10182715 DOI: 10.7759/cureus.37521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 05/18/2023] Open
Abstract
Background Despite abundant sunlight exposure, vitamin D deficiency remains a major challenge in Saudi Arabia. Meanwhile, the widespread use of vitamin D supplements has prompted concerns about toxicity, which although rare, can have severe health consequences. Objective The objective of this cross-sectional study was to analyze the prevalence and associated factors of iatrogenic vitamin D toxicity among the Saudi population of vitamin D users due to overcorrection. Methods An online questionnaire was used to collect data from 1,677 participants across all regions of Saudi Arabia. The questionnaire included responses on the prescription, duration of vitamin D intake, dosage, frequency, history of vitamin D toxicity, symptom onset, and duration. Results One thousand six hundred and seventy-seven responses were included across all regions of Saudi Arabia. A majority of participants were female (66.7%) and around half were aged 18-25 years. A history of vitamin D use was reported by 63.8% of participants, and 48% were still using vitamin D supplements. Most participants (79.3%) consulted a physician, and 84.8% had taken a vitamin D test before using the supplement. Commonly reported motives for taking vitamin D included vitamin D deficiency (72.1%), lack of sun exposure (26.1%), and hair loss (20.6%). Symptoms of overdose were reported by 6.6% of participants, with 3.3% having an overdose and 2.1% experiencing both overdose and symptoms. Conclusion This study showed that although a large portion of the Saudi population is taking vitamin D supplements, the prevalence of vitamin D toxicity is relatively low. However, this prevalence should not be ignored, and further research is needed to understand the factors contributing to vitamin D toxicity in order to minimize its occurrence.
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Affiliation(s)
- Faisal Aljehani
- Internal Medicine, College of Medicine, University of Jeddah, Jeddah, SAU
| | | | | | - Abdalaziz I Saadi
- Internal Medicine, College of Medicine, University of Jeddah, Jeddah, SAU
| | | | - Enad Alsolami
- Internal Medicine, College of Medicine, University of Jeddah, Jeddah, SAU
| | - Mohammed Alfawaz
- Internal Medicine, College of Medicine, University of Jeddah, Jeddah, SAU
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Abstract
IMPORTANCE Hypercalcemia affects approximately 1% of the worldwide population. Mild hypercalcemia, defined as total calcium of less than 12 mg/dL (<3 mmol/L) or ionized calcium of 5.6 to 8.0 mg/dL (1.4-2 mmol/L), is usually asymptomatic but may be associated with constitutional symptoms such as fatigue and constipation in approximately 20% of people. Hypercalcemia that is severe, defined as total calcium of 14 mg/dL or greater (>3.5 mmol/L) or ionized calcium of 10 mg/dL or greater (≥2.5 mmol/L) or that develops rapidly over days to weeks, can cause nausea, vomiting, dehydration, confusion, somnolence, and coma. OBSERVATIONS Approximately 90% of people with hypercalcemia have primary hyperparathyroidism (PHPT) or malignancy. Additional causes of hypercalcemia include granulomatous disease such as sarcoidosis, endocrinopathies such as thyroid disease, immobilization, genetic disorders, and medications such as thiazide diuretics and supplements such as calcium, vitamin D, or vitamin A. Hypercalcemia has been associated with sodium-glucose cotransporter 2 protein inhibitors, immune checkpoint inhibitors, denosumab discontinuation, SARS-CoV-2, ketogenic diets, and extreme exercise, but these account for less than 1% of causes. Serum intact parathyroid hormone (PTH), the most important initial test to evaluate hypercalcemia, distinguishes PTH-dependent from PTH-independent causes. In a patient with hypercalcemia, an elevated or normal PTH concentration is consistent with PHPT, while a suppressed PTH level (<20 pg/mL depending on assay) indicates another cause. Mild hypercalcemia usually does not need acute intervention. If due to PHPT, parathyroidectomy may be considered depending on age, serum calcium level, and kidney or skeletal involvement. In patients older than 50 years with serum calcium levels less than 1 mg above the upper normal limit and no evidence of skeletal or kidney disease, observation may be appropriate. Initial therapy of symptomatic or severe hypercalcemia consists of hydration and intravenous bisphosphonates, such as zoledronic acid or pamidronate. In patients with kidney failure, denosumab and dialysis may be indicated. Glucocorticoids may be used as primary treatment when hypercalcemia is due to excessive intestinal calcium absorption (vitamin D intoxication, granulomatous disorders, some lymphomas). Treatment reduces serum calcium and improves symptoms, at least transiently. The underlying cause of hypercalcemia should be identified and treated. The prognosis for asymptomatic PHPT is excellent with either medical or surgical management. Hypercalcemia of malignancy is associated with poor survival. CONCLUSIONS AND RELEVANCE Mild hypercalcemia is typically asymptomatic, while severe hypercalcemia is associated with nausea, vomiting, dehydration, confusion, somnolence, and coma. Asymptomatic hypercalcemia due to primary hyperparathyroidism is managed with parathyroidectomy or observation with monitoring, while severe hypercalcemia is typically treated with hydration and intravenous bisphosphonates.
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Affiliation(s)
- Marcella Donovan Walker
- Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, New York
| | - Elizabeth Shane
- Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, New York
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4
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Chang EL, Kline MD, Sundararajan R, Nguyen MB. Medications Without Borders: Themes in Caregiver Administration of Imported Medications in Pediatrics. Pediatr Emerg Care 2022; 38:526-531. [PMID: 35507378 DOI: 10.1097/pec.0000000000002716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to identify motivating factors in why parents administer imported medications to their children. METHODS In this qualitative study, we enrolled caregivers of patients younger than 18 years who presented for care at a pediatric emergency department. The study team conducted face-to-face interviews with caregivers in the emergency department and used a semistructured question guide to probe for themes regarding the use of imported medications in children. Interviews were recorded, transcribed, translated if necessary, and coded. We applied grounded theory methodology to assess for themes and adapted the Andersen model of health care utilization to provide a framework for the identified themes. RESULTS We completed 30 interviews, 9 of which were conducted in Spanish. Themes surrounding imported medication usage were categorized into predisposing, enabling, and need factors. Predisposing factors included perception that an ill child needs medication to get better, perception of medication quality, and past experiences with medications. Enabling factors included proximity to foreign countries, cost, limited access to primary care, and convenience of obtaining medications. Need factors included utilization of foreign medications for a "simple illness" and utilization of foreign care for a "second opinion." CONCLUSIONS Our study used qualitative methodology to gain important insights into the caregiver experience of a diverse patient population. We identify themes not previously published in the medication importation literature. These concepts can provide insights in educational strategies aimed at mitigating the potential dangers of imported medication use in pediatrics.
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Affiliation(s)
- Elizabeth L Chang
- From the University of California San Diego School of Medicine, San Diego, CA
| | | | | | - Margaret B Nguyen
- From the University of California San Diego School of Medicine, San Diego, CA
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5
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Gérard AO, Fresse A, Gast M, Merino D, Gourdan P, Laurain A, Margaritis I, Gauci PA, Huret F, Parassol N, Rocher F. Case Report: Severe Hypercalcemia Following Vitamin D Intoxication in an Infant, the Underestimated Danger of Dietary Supplements. Front Pediatr 2022; 10:816965. [PMID: 35178365 PMCID: PMC8844365 DOI: 10.3389/fped.2022.816965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/10/2022] [Indexed: 11/15/2022] Open
Abstract
Vitamin D supplementation is routinely introduced in infants, according to medical guidelines. However, vitamin D overdose can result in life-threatening hypercalcemia. We report the case of a 3-month-old infant who suffered from severe hypercalcemia. Upon detailed questioning of the parents, a vitamin D administration error has been identified. Indeed, the parents had followed the advice of their midwife. They substituted the prescribed medicinal vitamin D by a dietary supplement, different in concentration and dosing, without performing the dose conversion needed. In fact, many different medications and dietary supplements with vitamin D exist, offering various concentrations and units of measurement. This case highlights the pivotal role of therapeutic education. Broadly, there is a need for harmonization of the regulation and labeling of dietary supplements and medications containing vitamin D.
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Affiliation(s)
- Alexandre O Gérard
- Department of Nephrology-Dialysis-Transplantation, Centre Hospitalier Universitaire de Nice, Nice, France.,Department of Pharmacology and Pharmacovigilance Center of Nice, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Audrey Fresse
- Department of Pharmacology and Pharmacovigilance Center of Nice, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Myriam Gast
- Department of Pediatry, Hospital Center of Bastia, Bastia, France
| | - Diane Merino
- Department of Pharmacology and Pharmacovigilance Center of Nice, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Pierre Gourdan
- Department of Pediatry, Lenval Hospital - Centre Hospitalier Universitaire de Nice, Nice, France
| | - Audrey Laurain
- Department of Nephrology-Dialysis-Transplantation, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Irène Margaritis
- Nutrition Risk Assessment Unit, French Agency for Food, Environmental and Occupational Health & Safety (ANSES), Maisons-Alfort, France
| | - Pierre-Alexis Gauci
- Department of Gynecology, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Fanny Huret
- Nutrition Risk Assessment Unit, French Agency for Food, Environmental and Occupational Health & Safety (ANSES), Maisons-Alfort, France
| | - Nadège Parassol
- Department of Pharmacology and Pharmacovigilance Center of Nice, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Fanny Rocher
- Department of Pharmacology and Pharmacovigilance Center of Nice, Centre Hospitalier Universitaire de Nice, Nice, France
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6
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Abstract
This review focuses on the commonly prescribed medicaments that can be responsible for hypercalcemia, considering the prevalence, the predominant pathophysiological mechanisms, and the optimal medical management of each drug-induced hypercalcemia. Vitamin D supplements and 1α-hydroxylated vitamin D analogues increase intestinal calcium absorption, renal calcium reabsorption as well as bone resorption. In patients with hypoparathyroidism receiving recombinant human PTH, transient hypercalcemia can occur because of overtreatment, usually during acute illness. Thiazide-induced hypercalcemia is mainly explained by enhanced renal proximal calcium reabsorption, changing preexistent asymptomatic normocalcemic or intermittently hypercalcemic hyperparathyroidism into the classic hypercalcemic hyperparathyroidism. Lithium causes hypercalcemia mainly by drug-induced hyperparathyroidism.
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Affiliation(s)
- Anne-Lise Lecoq
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphate, Filière OSCAR, 78 rue du Général Leclerc, Le Kremlin Bicêtre 94270, France
| | - Marine Livrozet
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Centre d'Investigations Cliniques 1418, 20 Rue Leblanc, Paris 75015, France
| | - Anne Blanchard
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Centre d'Investigations Cliniques 1418, 20 Rue Leblanc, Paris 75015, France
| | - Peter Kamenický
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphate, Filière OSCAR, 78 rue du Général Leclerc, Le Kremlin Bicêtre 94270, France; Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Le Kremlin-Bicêtre 94276, France.
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7
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Forget the phosphorus: A case of hypervitaminosis D-induced symptomatic hypercalcemia. Clin Nephrol Case Stud 2021; 9:1-3. [PMID: 33614397 PMCID: PMC7890937 DOI: 10.5414/cncs110414] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/24/2020] [Indexed: 12/25/2022] Open
Abstract
Hypercalcemia is a frequently encountered electrolyte abnormality with a well-described differential diagnosis and classic algorithm for evaluation. The treatment for hypercalcemia is dependent on the underlying etiology. Hypervitaminosis D is an uncommon cause of hypercalcemia, but the use of vitamin D supplementation has expanded and case reports of supplemental vitamin D induced hypercalcemia have become more frequent. We present a case of hypervitaminosis D-induced altered mental status where diagnosis was delayed and additional invasive testing was performed due to an assumption regarding phosphatemia.
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Farnaghi F, Hassanian-Moghaddam H, Zamani N, Gholami N, Gachkar L, Hosseini Yazdi M. Vitamin D toxicity in a pediatric toxicological referral center; a cross-sectional study from Iran. BMC Pediatr 2020; 20:350. [PMID: 32684163 PMCID: PMC7370494 DOI: 10.1186/s12887-020-02240-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/06/2020] [Indexed: 11/17/2022] Open
Abstract
Background Vitamin D is an essential element for body health with its supplements generally administered to prevent vitamin D deficiency. Since these supplements are available in domestic settings, vitamin D toxicity may happen in children. Methods All children younger than 12 years who presented to the pediatric emergency department of Loghman Hakim Hospital, Tehran, Iran with history of ingestion of more than 1500 IU/day of vitamin D supplements were enrolled. Patients’ demographic data, on-presentation signs and symptoms, laboratory findings, treatments given, and outcome were evaluated. Result Fifteen patients presented during the study period. Their mean age was 46.53 ± 10.14 months and 12 (80%) were girls. All of them had unintentionally ingested vitamin D. Mean ingested dose was 406700.7 ± 227400.1 IU. In eight patients (53.3%), 25 hydroxy vitamin D level was more than 100 ng/mL. One patient experienced hypercalcemia while all of them were asymptomatic and discharged without complications. There was no significant difference between patients with and without high levels of 25 OH vitamin D regarding lab tests, toxicity course, and outcome. Conclusions It seems that acute vitamin D toxicity is a benign condition in our pediatric population which may be due to high prevalence of vitamin D deficiency in Iran.
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Affiliation(s)
- Fariba Farnaghi
- Departments of pediatrics, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, South Kargar St, Makhsos St,, Tehran, Iran
| | - Hossein Hassanian-Moghaddam
- Department of Clinical Toxicology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasim Zamani
- Department of Clinical Toxicology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Narges Gholami
- Departments of pediatrics, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, South Kargar St, Makhsos St,, Tehran, Iran.
| | - Latif Gachkar
- Infectious and Tropical Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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de Paula ALT, Gonzaga WPF, Oliveira LM, Feibelmann TCM, Markus J. Exogenous intoxication by non-prescribed use of vitamin D, a case report. BMC Geriatr 2020; 20:221. [PMID: 32580697 PMCID: PMC7315533 DOI: 10.1186/s12877-020-01614-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/15/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This case report, unlike the current literature related to vitamin D intoxication, aims to highlight the risk of self-medication, and how publicity boosts the acquisition of vitamins for different purposes, increasing consumption with no professional indication or supervision. This practice can pose a serious health risk to the population. CASE PRESENTATION Our patient, a brazilian retired 64-year-old female, presented to the emergency service with post-prandial food vomiting of undigested content and stabbing abdominal pain with worsening during palpation. Concomitantly, onset of sporadic frontal headache, fatigue, hyporexia, weight loss of 18 kg in the same period, severe pruritus, musculoskeletal pain in the limbs and nocturia. The physical examination showed hypertension (160/80 mmHg) and itchy macules in the lower limb. Initially, the main diagnostic hypotheses were multiple myeloma, hyperparathyroidism and pancreatitis secondary to hypercalcemia, osteolytic neoplasms and other neoplasms that present with hypercalcemia. However, blood count, parathyroid hormone, chest X-ray, immunoglobulins, myelogram and bone marrow biopsy were not compatible with these diagnoses. Meanwhile, 25 OH vitamin D dosage and diluted vitamin D test confirmed the diagnosis of hypervitaminosis D. Hypercalcemic crisis was managed with vigorous hydration (50 ml/kg in 2 h), furosemide, bisphosphonates and blood pressure control with amlodipine and atenolol. Subsequently, the patient was discharged from the outpatient clinic with complete remission of symptoms, weight gain, serum calcium values of 10.76 mg/dL and ionizable calcium values of 6.52 mg/dL. CONCLUSION Our report summarizes the possible consequences of using a vitamin compound without supervision of a competent professional, as these substances are mistakenly considered non-toxic. To add, little information is available about the supplements' metabolism and their biological effects. Therefore, It is difficult to diagnose intoxication. This case report shows that even the self-administration of a product designed to bring health benefits can become a risky behavior. These vitamin and mineral supplements are supposed to bring patient empowerment and reduce government spending in health-care, but indeed represent a significant public health concern due to possible overdose and drug interactions.
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Affiliation(s)
- Ana Laura Teodoro de Paula
- Medical Doctorate Degree, Faculty of Medicine, Federal University of Uberlândia, Av Pará, 1720, Uberlândia, Minas Gerais, 38405-320, Brazil
| | - Wemerson Philipe Ferreira Gonzaga
- Medical Doctorate Degree, Faculty of Medicine, Federal University of Uberlândia, Av Pará, 1720, Uberlândia, Minas Gerais, 38405-320, Brazil
| | - Lucas Martins Oliveira
- Medical Doctorate Degree, Faculty of Medicine, Federal University of Uberlândia, Av Pará, 1720, Uberlândia, Minas Gerais, 38405-320, Brazil.
| | | | - Juliana Markus
- Internal Medicine Department, Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
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Charen E, Harbord N. Toxicity of Herbs, Vitamins, and Supplements. Adv Chronic Kidney Dis 2020; 27:67-71. [PMID: 32147004 DOI: 10.1053/j.ackd.2019.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 08/01/2019] [Indexed: 12/15/2022]
Abstract
In the United States, the Food and Drug Administration regulates the efficacy and safety of pharmaceutical drugs. This government agency was formed in direct response to a mass poisoning and more than 100 deaths from kidney failure due to a medicinal toxic alcohol exposure. In contrast, the Food and Drug Administration also regulates the use of vitamins, minerals, herbs, or botanicals as dietary supplements, banning specific medical claims but requiring no documentation of efficacy. Safety of dietary supplements is only ensured through reporting of adverse events and rarely through intervention. Consumers should be aware that supplements may in fact contain actual pharmaceuticals or nothing of value and have significant toxic potential. Toxicity due to Chinese herbal medicines, aristolochic acid, amygdalin, hypervitaminosis D, and heavy metal contamination is reviewed.
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11
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Kojima A, Sato Y, Nishijima C, Umegaki K, Chiba T. Systematic Review of Case Reports on the Adverse Events Due to Health Food Intake by Cancer Patients. YAKUGAKU ZASSHI 2019; 139:1333-1347. [DOI: 10.1248/yakushi.19-00116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Ayako Kojima
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition
| | - Yoko Sato
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition
| | - Chiharu Nishijima
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition
| | - Keizo Umegaki
- Department of Food Safety and Management, Showa Women's University
| | - Tsuyoshi Chiba
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition
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12
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Singh P, Kumar M, Al Khodor S. Vitamin D Deficiency in the Gulf Cooperation Council: Exploring the Triad of Genetic Predisposition, the Gut Microbiome and the Immune System. Front Immunol 2019; 10:1042. [PMID: 31134092 PMCID: PMC6524467 DOI: 10.3389/fimmu.2019.01042] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 04/24/2019] [Indexed: 02/06/2023] Open
Abstract
Vitamin D is a fat soluble secosteroid that is primarily synthesized in the skin upon exposure to Ultraviolet B (UVB) sun rays. Vitamin D is essential for the growth and development of bones and helps in reducing inflammation by strengthening muscles and the immune system. Despite the endless supply of sunlight in the Gulf Cooperation Council (GCC) countries which includes United Arab Emirates, Qatar, Kuwait, Bahrain, Saudi Arabia, and Oman, Vitamin D deficiency in the (GCC) general population at various age groups remains alarmingly high. In parallel runs the increasing prevalence of acute and chronic illnesses including, autoimmune diseases, cancer, type 1 diabetes mellitus, cardiovascular disease and Inflammatory bowel disease in the adult as well as the pediatric population of these countries. The exact association between Vitamin D deficiency and chronic disease conditions remains unclear; however, studies have focused on the mechanism of Vitamin D regulation by assessing the role of the Vitamin D associated genes/proteins such as VDR (Vitamin D receptor), VDBP (Vitamin D Binding protein), CYP27B1 as these are integral parts of the Vitamin D signaling pathway. VDR is known to regulate the expression of more than 200 genes across a wide array of tissues in the human body and may play a role in controlling the Vitamin D levels. Moreover, reduced Vitamin D level and downregulation of VDR have been linked to gut dysbiosis, highlighting an intriguing role for the gut microbiome in the Vitamin D metabolism. However, this role is not fully described yet. In this review, we aim to expand our understanding of the causes of Vitamin D deficiency in the GCC countries and explore the potential relationship between the genetic predisposition, Vitamin D levels, immune system and the gut microbiome composition. Trying to unravel this complex interaction may aid in understanding the mechanism by which Vitamin D contributes to various disease conditions and will pave the way toward new therapeutics treatments for Vitamin D deficiency and its associated outcomes.
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Affiliation(s)
- Parul Singh
- Research Department, Sidra Medicine, Doha, Qatar
| | - Manoj Kumar
- Research Department, Sidra Medicine, Doha, Qatar
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13
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Malihi Z, Wu Z, Lawes CMM, Scragg R. Adverse events from large dose vitamin D supplementation taken for one year or longer. J Steroid Biochem Mol Biol 2019; 188:29-37. [PMID: 30529281 DOI: 10.1016/j.jsbmb.2018.12.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 11/23/2018] [Accepted: 12/06/2018] [Indexed: 02/07/2023]
Abstract
In recent years, clinical trials increasingly have given large doses of vitamin D supplements to investigate possible health benefits beyond bone at high 25-hydroxyvitamin D levels. However, there are few publications on the safety of high-dose vitamin D given long term. The study objective was to investigate the cumulative relative risk (RR) of total adverse events, kidney stones, hypercalcemia and hypercalciuria from ≥2800 IU/d vitamin D2 or D3 supplementation, followed for one year or more in randomized controlled trials (RCTs). A systematic review was conducted in Medline Ovid, EMBASE and Cochrane in March 2018 to update results of studies published since a previous review in October 2015. RCTs were included if they gave vitamin D2 or D3 at ≥2800 IU/d for at least one year and reported on total adverse events or at least one calcium-related adverse event. There were a total of 32 studies that met the inclusion criteria. Of these, only 15 studies (3150 participants) reported one or more event of the outcomes of interest. Long-term high-dose vitamin D supplementation did not increase total adverse events compared to placebo in 1731 participants from 10 studies (RR = 1.05; 95% CI = 0.88, 1.24; p = 0.61), nor kidney stones in 1336 participants from 5 studies (RR = 1.26; 95% CI = 0.35, 4.58; p = 0.72). However, there was a trend for vitamin D to increase risk of hypercalcemia in 2598 participants from 10 studies (RR = 1.93; 95% CI = 1.00, 3.73; p = 0.05); while its effect on hypercalciuria in only 276 participants from 3 studies was inconclusive (RR = 1.93; 95% CI = 0.83, 4.46; p = 0.12). In conclusion, one year or longer supplementation with a large daily, weekly or monthly dose of vitamin D2 /D3 did not significantly increase a risk of total adverse events or kidney stones, although there was a trend towards increased hypercalcemia, and possibly for hypercalciuria.
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Affiliation(s)
- Z Malihi
- School of Population Health, University of Auckland, New Zealand
| | - Zhenqiang Wu
- School of Population Health, University of Auckland, New Zealand
| | | | - Robert Scragg
- School of Population Health, University of Auckland, New Zealand.
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Kojima A, Sato Y, Chiba T, Umegaki K. [Notable Adverse Events Associated with Concomitant Use of Health Foods and Drugs Derived from the Analysis of HFNet Data on the Safety and Effectiveness of Health Foods]. Food Hygiene and Safety Science (Shokuhin Eiseigaku Zasshi) 2018; 59:80-88. [PMID: 29695676 DOI: 10.3358/shokueishi.59.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Health foods are commonly consumed at their own discretion by patients with various diseases who are also being treated with conventional drugs. Both health foods and drugs are diverse, and enormous numbers of possible combinations exist, so that it is very difficult to identify adverse events that may occur due to their interactions. Here, we analyzed the characteristics of adverse events related to the concomitant use of health foods and drugs using data from the "Information system on safety and effectiveness for health foods (HFNet)" website (https://hfnet.nibiohn.go.jp/) compiled by the Food Function and Labeling Department of the National Institute of Health and Nutrition of Japan. We identified 64 reports and 71 patients, and characterized them according to symptom severity and drug classification. The analysis revealed that symptoms of liver dysfunction were mainly reported in patients receiving high-risk drugs, such as antiepileptic, antineoplastic, antiarrhythmic, and antithrombotic drugs, concomitantly with health foods or drugs. However, journal articles describing health food and drug interactions generally did not provide sufficient information about the ingredients of the health foods.
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Affiliation(s)
- Ayako Kojima
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition
| | - Yoko Sato
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition
| | - Tsuyoshi Chiba
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition
| | - Keizo Umegaki
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition.,Department of Food Safety and Management, Showa Women's University
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15
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Taylor PN, Davies JS. A review of the growing risk of vitamin D toxicity from inappropriate practice. Br J Clin Pharmacol 2018; 84:1121-1127. [PMID: 29498758 DOI: 10.1111/bcp.13573] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 02/05/2018] [Accepted: 02/10/2018] [Indexed: 12/27/2022] Open
Abstract
Vitamin D is a particularly important sterol hormone, with evidence emerging of its beneficial effects well beyond bone. In consequence of this and increased global recognition of vitamin D deficiency in the general population, there has been a resurgence in treatment with vitamin D preparations. However, the increasing use of vitamin D treatments has also seen a substantial increase in the number of reports of vitamin D intoxication, with the majority (75%) of reports published since 2010. Many of these cases are a consequence of inappropriate prescribing, and the use of high-dose over-the-counter preparations or unlicensed preparations. This review highlights that the majority of cases were preventable and discusses the inappropriate use of poorly formulated, and unlicensed vitamin D preparations.
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Affiliation(s)
- Peter N Taylor
- Lecturer, Division of Infection and Immunity, School of Medicine Cardiff University, Heath Park, Cardiff, CF14 4XN, UK
| | - J Stephen Davies
- Consultant Endocrinologist, Department of Endocrinology, University Hospital of Wales, Cardiff, CF14 4XJ, UK
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Di Maio S, Soliman AT, De Sanctis V, Kattamis CC. Current treatment of hypoparathyroidism: Theory versus reality waiting guidelines for children and adolescents. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:122-131. [PMID: 29633734 PMCID: PMC6357623 DOI: 10.23750/abm.v89i1.7118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 02/21/2018] [Indexed: 12/22/2022]
Abstract
The diagnosis of hypoparathyroidism(HPT)is readily made in the presence of hypocalcemia with markedly reduced or absent parathormone (PTH) levels. Currently available treatments for HPT include high dose vitamin D (ergocalciferol, D2 and cholecalciferol, D3) or, the active metabolite dihydroxy vitamin D (calcitriol), in addition to calcium supplements.This regimen, if not well monitored, can lead to hypercalciuria, as PTH deficiency impairs renal calcium reabsorption. Thus the goal of treatment, is to maintain serum calcium at the low end of the normal range. Undertreatment can cause symptomatic hypocalcemia, while overtreatment hypercalciuria, which may lead to nephrolithiasis, nephrocalcinosis, and renal insufficiency. At present, there is no consensus on the management of HPT in children and adolescents and only few studies are available on the long term outcome of patients with recombinant HPT treatment. The purpose of this article is to review, in a comprehensive manner, the major aspects of HPT management in children and adolescents waiting for authoritative guidelines for the treatment of HPT in this group of patients. Further research, addressing specific questions for this population are urgently needed to improve long-term safety of patients. Educational interventions are also needed for professionals, parents and patients to enable them to improve knowledge, quality of life and effective management care at home. (www.actabiomedica.it)
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Affiliation(s)
- Salvatore Di Maio
- Emeritus Director in Pediatrics, Santobono-Pausilipon Children's Hospital, Naples, Italy.
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Wimalawansa SJ. Associations of vitamin D with insulin resistance, obesity, type 2 diabetes, and metabolic syndrome. J Steroid Biochem Mol Biol 2018; 175:177-189. [PMID: 27662816 DOI: 10.1016/j.jsbmb.2016.09.017] [Citation(s) in RCA: 166] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/15/2016] [Accepted: 09/19/2016] [Indexed: 12/23/2022]
Abstract
The aim of this study is to determine the relationships of vitamin D with diabetes, insulin resistance obesity, and metabolic syndrome. Intra cellular vitamin D receptors and the 1-α hydroxylase enzyme are distributed ubiquitously in all tissues suggesting a multitude of functions of vitamin D. It plays an indirect but an important role in carbohydrate and lipid metabolism as reflected by its association with type 2 diabetes (T2D), metabolic syndrome, insulin secretion, insulin resistance, polycystic ovarian syndrome, and obesity. Peer-reviewed papers, related to the topic were extracted using key words, from PubMed, Medline, and other research databases. Correlations of vitamin D with diabetes, insulin resistance and metabolic syndrome were examined for this evidence-based review. In addition to the well-studied musculoskeletal effects, vitamin D decreases the insulin resistance, severity of T2D, prediabetes, metabolic syndrome, inflammation, and autoimmunity. Vitamin D exerts autocrine and paracrine effects such as direct intra-cellular effects via its receptors and the local production of 1,25(OH)2D3, especially in muscle and pancreatic β-cells. It also regulates calcium homeostasis and calcium flux through cell membranes, and activation of a cascade of key enzymes and cofactors associated with metabolic pathways. Cross-sectional, observational, and ecological studies reported inverse correlations between vitamin D status with hyperglycemia and glycemic control in patients with T2D, decrease the rate of conversion of prediabetes to diabetes, and obesity. However, no firm conclusions can be drawn from current studies, because (A) studies were underpowered; (B) few were designed for glycemic outcomes, (C) the minimum (or median) serum 25(OH) D levels achieved are not measured or reported; (D) most did not report the use of diabetes medications; (E) some trials used too little (F) others used too large, unphysiological and infrequent doses of vitamin D; and (G) relative paucity of rigorous clinical data on the effects of vitamin D sufficiency on non-calcium endpoints. Although a large number of observational studies support improving T2D, insulin resistance, obesity, and metabolic syndrome with vitamin D adequacy, there is a lack of conclusive evidence from randomized control clinical trials that, these disorders are prevented following optimization of serum levels of 25(OH)D. However, none of the currently conducted clinical studies would resolve these issues. Thus, specifically designed, new clinical studies are needed to be conducted in well-defined populations, following normalizing the serum vitamin D levels in vitamin D deficient prediabetes subjects, to test the hypothesis that hypovitaminosis D worsens these disorders and correction would alleviate it.
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Affiliation(s)
- Sunil J Wimalawansa
- Endocrinology, Metabolisum & Nutrition, Cardio Metabolic Institute, NJ, USA.
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Altieri B, Muscogiuri G, Barrea L, Mathieu C, Vallone CV, Mascitelli L, Bizzaro G, Altieri VM, Tirabassi G, Balercia G, Savastano S, Bizzaro N, Ronchi CL, Colao A, Pontecorvi A, Della Casa S. Does vitamin D play a role in autoimmune endocrine disorders? A proof of concept. Rev Endocr Metab Disord 2017; 18:335-346. [PMID: 28070798 DOI: 10.1007/s11154-016-9405-9] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In the last few years, more attention has been given to the "non-calcemic" effect of vitamin D. Several observational studies and meta-analyses demonstrated an association between circulating levels of vitamin D and outcome of many common diseases, including endocrine diseases, chronic diseases, cancer progression, and autoimmune diseases. In particular, cells of the immune system (B cells, T cells, and antigen presenting cells), due to the expression of 1α-hydroxylase (CYP27B1), are able to synthesize the active metabolite of vitamin D, which shows immunomodulatory properties. Moreover, the expression of the vitamin D receptor (VDR) in these cells suggests a local action of vitamin D in the immune response. These findings are supported by the correlation between the polymorphisms of the VDR or the CYP27B1 gene and the pathogenesis of several autoimmune diseases. Currently, the optimal plasma 25-hydroxyvitamin D concentration that is necessary to prevent or treat autoimmune diseases is still under debate. However, experimental studies in humans have suggested beneficial effects of vitamin D supplementation in reducing the severity of disease activity. In this review, we summarize the evidence regarding the role of vitamin D in the pathogenesis of autoimmune endocrine diseases, including type 1 diabetes mellitus, Addison's disease, Hashimoto's thyroiditis, Graves' disease and autoimmune polyendocrine syndromes. Furthermore, we discuss the supplementation with vitamin D to prevent or treat autoimmune diseases.
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Affiliation(s)
- Barbara Altieri
- Division of Endocrinology and Metabolic Diseases, Institute of Medical Pathology, Catholic University of the Sacred Heart, Rome, Italy.
| | - Giovanna Muscogiuri
- Ios and Coleman Medicina Futura Medical Center, University Federico II, Naples, Italy
| | - Luigi Barrea
- Ios and Coleman Medicina Futura Medical Center, University Federico II, Naples, Italy
| | - Chantal Mathieu
- Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - Carla V Vallone
- Emergency Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Luca Mascitelli
- Comando Brigata Alpina Julia/Multinational Land Force, Medical Service, Udine, Italy
| | | | | | - Giacomo Tirabassi
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Giancarlo Balercia
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Silvia Savastano
- Department of Clinical Medicine and Surgery, University "Federico II", Naples, Italy
| | - Nicola Bizzaro
- Laboratory of Clinical Pathology, San Antonio Hospital, Tolmezzo, Italy
| | - Cristina L Ronchi
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery, University "Federico II", Naples, Italy
| | - Alfredo Pontecorvi
- Division of Endocrinology and Metabolic Diseases, Institute of Medical Pathology, Catholic University of the Sacred Heart, Rome, Italy
| | - Silvia Della Casa
- Division of Endocrinology and Metabolic Diseases, Institute of Medical Pathology, Catholic University of the Sacred Heart, Rome, Italy
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Crone M, Fogarty K. A case report: hypercalcemia due to vitamin supplementation in a patient with neurofibromatosis. CLINICAL CASES IN MINERAL AND BONE METABOLISM : THE OFFICIAL JOURNAL OF THE ITALIAN SOCIETY OF OSTEOPOROSIS, MINERAL METABOLISM, AND SKELETAL DISEASES 2017; 14:87-88. [PMID: 28740531 PMCID: PMC5505720 DOI: 10.11138/ccmbm/2017.14.1.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 54-year-old female with history of neurofibromatosis who presented with severe hypercalcemia and renal failure secondary to over supplementation of calcium and vitamin D.
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Affiliation(s)
- Michael Crone
- College of Osteopathic Medicine, Touro University California, Vallejo, USA
| | - Kelly Fogarty
- College of Osteopathic Medicine, Touro University California, Vallejo, USA
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20
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Abstract
Hypercalcemia occurs in up to 4% of the population in association with malignancy, primary hyperparathyroidism, ingestion of excessive calcium and/or vitamin D, ectopic production of 1,25-dihydroxyvitamin D [1,25(OH)2D], and impaired degradation of 1,25(OH)2D. The ingestion of excessive amounts of vitamin D3 (or vitamin D2) results in hypercalcemia and hypercalciuria due to the formation of supraphysiological amounts of 25-hydroxyvitamin D [25(OH)D] that bind to the vitamin D receptor, albeit with lower affinity than the active form of the vitamin, 1,25(OH)2D, and the formation of 5,6-trans 25(OH)D, which binds to the vitamin D receptor more tightly than 25(OH)D. In patients with granulomatous disease such as sarcoidosis or tuberculosis and tumors such as lymphomas, hypercalcemia occurs as a result of the activity of ectopic 25(OH)D-1-hydroxylase (CYP27B1) expressed in macrophages or tumor cells and the formation of excessive amounts of 1,25(OH)2D. Recent work has identified a novel cause of non-PTH-mediated hypercalcemia that occurs when the degradation of 1,25(OH)2D is impaired as a result of mutations of the 1,25(OH)2D-24-hydroxylase cytochrome P450 (CYP24A1). Patients with biallelic and, in some instances, monoallelic mutations of the CYP24A1 gene have elevated serum calcium concentrations associated with elevated serum 1,25(OH)2D, suppressed PTH concentrations, hypercalciuria, nephrocalcinosis, nephrolithiasis, and on occasion, reduced bone density. Of interest, first-time calcium renal stone formers have elevated 1,25(OH)2D and evidence of impaired 24-hydroxylase-mediated 1,25(OH)2D degradation. We will describe the biochemical processes associated with the synthesis and degradation of various vitamin D metabolites, the clinical features of the vitamin D-mediated hypercalcemia, their biochemical diagnosis, and treatment.
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Affiliation(s)
- Peter J Tebben
- Divisions of Endocrinology (P.J.T., R.K.) and Nephrology and Hypertension (R.K.), and Departments of Pediatric and Adolescent Medicine (P.J.T.), Internal Medicine (P.J.T., R.K.), Laboratory Medicine and Pathology (R.J.S.), and Biochemistry in Molecular Biology (R.K.), Mayo Clinic College of Medicine, Rochester, Minnesota 55905
| | - Ravinder J Singh
- Divisions of Endocrinology (P.J.T., R.K.) and Nephrology and Hypertension (R.K.), and Departments of Pediatric and Adolescent Medicine (P.J.T.), Internal Medicine (P.J.T., R.K.), Laboratory Medicine and Pathology (R.J.S.), and Biochemistry in Molecular Biology (R.K.), Mayo Clinic College of Medicine, Rochester, Minnesota 55905
| | - Rajiv Kumar
- Divisions of Endocrinology (P.J.T., R.K.) and Nephrology and Hypertension (R.K.), and Departments of Pediatric and Adolescent Medicine (P.J.T.), Internal Medicine (P.J.T., R.K.), Laboratory Medicine and Pathology (R.J.S.), and Biochemistry in Molecular Biology (R.K.), Mayo Clinic College of Medicine, Rochester, Minnesota 55905
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21
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Folate intakes from diet and supplements may place certain Canadians at risk for folic acid toxicity. Br J Nutr 2016; 116:1236-1245. [DOI: 10.1017/s000711451600307x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
AbstractTo examine the prevalence of folate inadequacy and toxicity based on usual intakes from food and supplements, as well as biomarkers of folate, secondary data analyses were performed using cross-sectional, nationally representative data from the Canadian Community Health Survey, Cycle 2.2 (n32 776), as well as biomarker data from the Canadian Health Measures Survey, Cycles 1, 2 and 3 (n15 754). On the basis of unfortified food sources, Canadians would struggle to consume adequate amounts of folate. When folate intakes from all food sources were considered, the overall prevalence of folate inadequacy was low across all age/sex groups, with the exception of females >70 years. However, >10 % of supplement users were above the tolerable upper intake level, increasing to almost 18 % when overage factors were accounted for. In addition, between 20 and 52 % of supplement users had elevated erythrocyte folate concentrations, depending on the cut-off used. Results from this study suggest that insufficient dietary intakes of folate in Canadians have been ameliorated because of the fortification policy, although folate inadequacy still exists across all age groups. However, supplement users appear to be at an increased risk of folic acid (FA) overconsumption as well as elevated erythrocyte folate. As such, the general population should be informed of the potential risks of FA overconsumption resulting from supplement use. This study suggests a need for more careful assessment of the risks and benefits of food fortification, particularly fortification above mandated levels, and FA supplement use in the general population.
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Bilezikian JP, Brandi ML, Cusano NE, Mannstadt M, Rejnmark L, Rizzoli R, Rubin MR, Winer KK, Liberman UA, Potts JT. Management of Hypoparathyroidism: Present and Future. J Clin Endocrinol Metab 2016; 101:2313-24. [PMID: 26938200 PMCID: PMC5393596 DOI: 10.1210/jc.2015-3910] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
CONTEXT Conventional management of hypoparathyroidism has focused upon maintaining the serum calcium with oral calcium and active vitamin D, often requiring high doses and giving rise to concerns about long-term consequences including renal and brain calcifications. Replacement therapy with PTH has recently become available. This paper summarizes the results of the findings and recommendations of the Working Group on Management of Hypoparathyroidism. EVIDENCE ACQUISITION Contributing authors reviewed the literature regarding physiology, pathophysiology, and nutritional aspects of hypoparathyroidism, management of acute hypocalcemia, clinical aspects of chronic management, and replacement therapy of hypoparathyroidism with PTH peptides. PubMed and other literature search engines were utilized. EVIDENCE SYNTHESIS Under normal circumstances, interactions between PTH and active vitamin D along with the dynamics of calcium and phosphorus absorption, renal tubular handing of those ions, and skeletal responsiveness help to maintain calcium homeostasis and skeletal health. In the absence of PTH, the gastrointestinal tract, kidneys, and skeleton are all affected, leading to hypocalcemia, hyperphosphatemia, reduced bone remodeling, and an inability to conserve filtered calcium. Acute hypocalcemia can be a medical emergency presenting with neuromuscular irritability. The recent availability of recombinant human PTH (1-84) has given hope that management of hypoparathyroidism with the missing hormone in this disorder will provide better control and reduced needs for calcium and vitamin D. CONCLUSIONS Hypoparathyroidism is associated with abnormal calcium and skeletal homeostasis. Control with calcium and active vitamin D can be a challenge. The availability of PTH (1-84) replacement therapy may usher new opportunities for better control with reduced supplementation requirements.
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Affiliation(s)
- John P Bilezikian
- Columbia University College of Physicians & Surgeons (J.P.B., N.E.C., M.R.R.), New York, New York 10032; Department of Surgery and Translational Medicine (M.L.B.), University of Florence, 50121 Florence, Italy; Massachusetts General Hospital (M.M., J.T.P.), Boston, Massachusetts 02114; Aarhus University Hospital (L.R.), 8000 Aarhus, Denmark; Geneva University Hospitals and Faculty of Medicine (R.R.), 1205 Geneva, Switzerland; Eunice Kennedy Shriver National Institute of Child Health and Human Development (K.K.W.), National Institutes of Health, Bethesda, Maryland 20892; and Sackler School of Medicine (U.A.L.), Tel Aviv University, Tel Aviv 6997801, Israel
| | - Maria Luisa Brandi
- Columbia University College of Physicians & Surgeons (J.P.B., N.E.C., M.R.R.), New York, New York 10032; Department of Surgery and Translational Medicine (M.L.B.), University of Florence, 50121 Florence, Italy; Massachusetts General Hospital (M.M., J.T.P.), Boston, Massachusetts 02114; Aarhus University Hospital (L.R.), 8000 Aarhus, Denmark; Geneva University Hospitals and Faculty of Medicine (R.R.), 1205 Geneva, Switzerland; Eunice Kennedy Shriver National Institute of Child Health and Human Development (K.K.W.), National Institutes of Health, Bethesda, Maryland 20892; and Sackler School of Medicine (U.A.L.), Tel Aviv University, Tel Aviv 6997801, Israel
| | - Natalie E Cusano
- Columbia University College of Physicians & Surgeons (J.P.B., N.E.C., M.R.R.), New York, New York 10032; Department of Surgery and Translational Medicine (M.L.B.), University of Florence, 50121 Florence, Italy; Massachusetts General Hospital (M.M., J.T.P.), Boston, Massachusetts 02114; Aarhus University Hospital (L.R.), 8000 Aarhus, Denmark; Geneva University Hospitals and Faculty of Medicine (R.R.), 1205 Geneva, Switzerland; Eunice Kennedy Shriver National Institute of Child Health and Human Development (K.K.W.), National Institutes of Health, Bethesda, Maryland 20892; and Sackler School of Medicine (U.A.L.), Tel Aviv University, Tel Aviv 6997801, Israel
| | - Michael Mannstadt
- Columbia University College of Physicians & Surgeons (J.P.B., N.E.C., M.R.R.), New York, New York 10032; Department of Surgery and Translational Medicine (M.L.B.), University of Florence, 50121 Florence, Italy; Massachusetts General Hospital (M.M., J.T.P.), Boston, Massachusetts 02114; Aarhus University Hospital (L.R.), 8000 Aarhus, Denmark; Geneva University Hospitals and Faculty of Medicine (R.R.), 1205 Geneva, Switzerland; Eunice Kennedy Shriver National Institute of Child Health and Human Development (K.K.W.), National Institutes of Health, Bethesda, Maryland 20892; and Sackler School of Medicine (U.A.L.), Tel Aviv University, Tel Aviv 6997801, Israel
| | - Lars Rejnmark
- Columbia University College of Physicians & Surgeons (J.P.B., N.E.C., M.R.R.), New York, New York 10032; Department of Surgery and Translational Medicine (M.L.B.), University of Florence, 50121 Florence, Italy; Massachusetts General Hospital (M.M., J.T.P.), Boston, Massachusetts 02114; Aarhus University Hospital (L.R.), 8000 Aarhus, Denmark; Geneva University Hospitals and Faculty of Medicine (R.R.), 1205 Geneva, Switzerland; Eunice Kennedy Shriver National Institute of Child Health and Human Development (K.K.W.), National Institutes of Health, Bethesda, Maryland 20892; and Sackler School of Medicine (U.A.L.), Tel Aviv University, Tel Aviv 6997801, Israel
| | - René Rizzoli
- Columbia University College of Physicians & Surgeons (J.P.B., N.E.C., M.R.R.), New York, New York 10032; Department of Surgery and Translational Medicine (M.L.B.), University of Florence, 50121 Florence, Italy; Massachusetts General Hospital (M.M., J.T.P.), Boston, Massachusetts 02114; Aarhus University Hospital (L.R.), 8000 Aarhus, Denmark; Geneva University Hospitals and Faculty of Medicine (R.R.), 1205 Geneva, Switzerland; Eunice Kennedy Shriver National Institute of Child Health and Human Development (K.K.W.), National Institutes of Health, Bethesda, Maryland 20892; and Sackler School of Medicine (U.A.L.), Tel Aviv University, Tel Aviv 6997801, Israel
| | - Mishaela R Rubin
- Columbia University College of Physicians & Surgeons (J.P.B., N.E.C., M.R.R.), New York, New York 10032; Department of Surgery and Translational Medicine (M.L.B.), University of Florence, 50121 Florence, Italy; Massachusetts General Hospital (M.M., J.T.P.), Boston, Massachusetts 02114; Aarhus University Hospital (L.R.), 8000 Aarhus, Denmark; Geneva University Hospitals and Faculty of Medicine (R.R.), 1205 Geneva, Switzerland; Eunice Kennedy Shriver National Institute of Child Health and Human Development (K.K.W.), National Institutes of Health, Bethesda, Maryland 20892; and Sackler School of Medicine (U.A.L.), Tel Aviv University, Tel Aviv 6997801, Israel
| | - Karen K Winer
- Columbia University College of Physicians & Surgeons (J.P.B., N.E.C., M.R.R.), New York, New York 10032; Department of Surgery and Translational Medicine (M.L.B.), University of Florence, 50121 Florence, Italy; Massachusetts General Hospital (M.M., J.T.P.), Boston, Massachusetts 02114; Aarhus University Hospital (L.R.), 8000 Aarhus, Denmark; Geneva University Hospitals and Faculty of Medicine (R.R.), 1205 Geneva, Switzerland; Eunice Kennedy Shriver National Institute of Child Health and Human Development (K.K.W.), National Institutes of Health, Bethesda, Maryland 20892; and Sackler School of Medicine (U.A.L.), Tel Aviv University, Tel Aviv 6997801, Israel
| | - Uri A Liberman
- Columbia University College of Physicians & Surgeons (J.P.B., N.E.C., M.R.R.), New York, New York 10032; Department of Surgery and Translational Medicine (M.L.B.), University of Florence, 50121 Florence, Italy; Massachusetts General Hospital (M.M., J.T.P.), Boston, Massachusetts 02114; Aarhus University Hospital (L.R.), 8000 Aarhus, Denmark; Geneva University Hospitals and Faculty of Medicine (R.R.), 1205 Geneva, Switzerland; Eunice Kennedy Shriver National Institute of Child Health and Human Development (K.K.W.), National Institutes of Health, Bethesda, Maryland 20892; and Sackler School of Medicine (U.A.L.), Tel Aviv University, Tel Aviv 6997801, Israel
| | - John T Potts
- Columbia University College of Physicians & Surgeons (J.P.B., N.E.C., M.R.R.), New York, New York 10032; Department of Surgery and Translational Medicine (M.L.B.), University of Florence, 50121 Florence, Italy; Massachusetts General Hospital (M.M., J.T.P.), Boston, Massachusetts 02114; Aarhus University Hospital (L.R.), 8000 Aarhus, Denmark; Geneva University Hospitals and Faculty of Medicine (R.R.), 1205 Geneva, Switzerland; Eunice Kennedy Shriver National Institute of Child Health and Human Development (K.K.W.), National Institutes of Health, Bethesda, Maryland 20892; and Sackler School of Medicine (U.A.L.), Tel Aviv University, Tel Aviv 6997801, Israel
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Pérez-Barrios C, Hernández-Álvarez E, Blanco-Navarro I, Pérez-Sacristán B, Granado-Lorencio F. Prevalence of hypercalcemia related to hypervitaminosis D in clinical practice. Clin Nutr 2016; 35:1354-1358. [PMID: 26995293 DOI: 10.1016/j.clnu.2016.02.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 02/19/2016] [Accepted: 02/25/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND & AIMS Recent interest in vitamin D has led to a substantial increase in the use of vitamin D supplements. Vitamin D intoxication may be a concern as hypervitaminosis D can result in irreversible calcification of soft tissues so that it is important to detect early markers of vitamin D intoxication. Our aim was to assess the simultaneous presence of biochemical markers of vitamin D toxicity (i.e. hypervitaminosis D, hypercalcemia) and determine the concentrations of 25-OH-vitamin D at which the risk of hypercalcemia, and thus toxicity, might begin. METHODS We evaluated retrospectively a 6-year period during which 25.567 samples were assessed for 25-OH-vitamin D status by UHPLC. Hypervitaminosis D was defined at serum 25-OH-vitamin D >160 nmol/L. Serum and urine calcium, phosphorus and iPTH were also recorded, if available. Medical history revision was performed in subjects displaying simultaneously hypervitaminosis D and hypercalcemia. RESULTS Overall, hypervitaminosis D was found in 475 samples (1.86%) of which 51 displayed hypercalcemia (11.1%). A total of 382 samples were identified as the first record of hypervitaminosis D and 39 presented hypercalcemia (10.2%), most of them at 25-OH-vitamin D levels between 161 and 375 nmol/L. Only in 15 subjects, hypercalcemia could be directly attributed to vitamin D and serum 25-OH-vitamin D ranged between 164 and 1139 nmol/l. In no case, serum calcium achieved concentrations considered as critical values (>13 mg/dl). CONCLUSION Hypercalcemia due to vitamin D represented <4% of the total hypervitaminosis D detected and <0.1% of the tests performed. However, a highly variable response was observed and most subjects presented hypercalcemia at serum concentrations of 25-OH-vitamin D < 375 nmol/L.
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Affiliation(s)
- C Pérez-Barrios
- Servicio de Bioquímica Clínica, Hospital Universitario Puerta de Hierro-Majadahonda, 28222, Madrid, Spain
| | - E Hernández-Álvarez
- Servicio de Bioquímica Clínica, Hospital Universitario Puerta de Hierro-Majadahonda, 28222, Madrid, Spain; Unidad de Vitaminas, Hospital Universitario Puerta de Hierro-Majadahonda, 28222, Madrid, Spain
| | - I Blanco-Navarro
- Servicio de Bioquímica Clínica, Hospital Universitario Puerta de Hierro-Majadahonda, 28222, Madrid, Spain; Unidad de Vitaminas, Hospital Universitario Puerta de Hierro-Majadahonda, 28222, Madrid, Spain
| | - B Pérez-Sacristán
- Unidad de Vitaminas, Hospital Universitario Puerta de Hierro-Majadahonda, 28222, Madrid, Spain
| | - F Granado-Lorencio
- Servicio de Bioquímica Clínica, Hospital Universitario Puerta de Hierro-Majadahonda, 28222, Madrid, Spain; Unidad de Vitaminas, Hospital Universitario Puerta de Hierro-Majadahonda, 28222, Madrid, Spain.
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Hawn TR, Shah JA, Kalman D. New tricks for old dogs: countering antibiotic resistance in tuberculosis with host-directed therapeutics. Immunol Rev 2015; 264:344-62. [PMID: 25703571 DOI: 10.1111/imr.12255] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Despite the availability of Mycobacterium tuberculosis (Mtb) drugs for over 50 years, tuberculosis (TB) remains at pandemic levels. New drugs are urgently needed for resistant strains, shortening duration of treatment, and targeting different stages of the disease, especially for treatment during human immunodeficiency virus co-infection. One solution to the conundrum that antibiotics kill the bacillus yet select for resistance is to target the host rather than the pathogen. Here, we discuss recent progress in so-called 'host-directed therapeutics' (HDTs), focusing on two general mechanistic strategies: (i) HDTs that disrupt Mtb pathogenesis in macrophages and (ii) immunomodulatory HDTs that facilitate protective immune responses that kill Mtb or reduce deleterious responses that exacerbate disease. HDTs hold significant promise as adjunctive therapies in that they are less likely to engender resistance, will likely have efficacy against antibiotic-resistant strains, and may have activity against non-replicating Mtb. However, TB is a complex and variegated disease, and human populations exhibit significant diversity in their immune responses to it, which presents a complicated landscape for HDTs to navigate. Nevertheless, we suggest that a detailed mechanistic understanding of drug action, together with careful selection of disease stage targets and dosing strategies may overcome such limitations and allow the development of HDTs as effective adjunctive treatment options for TB.
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Affiliation(s)
- Thomas R Hawn
- Department of Medicine, University of Washington, Seattle, WA, USA
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Davies JS, Poole CD, Feldschreiber P. The medico-legal aspects of prescribing vitamin D. Br J Clin Pharmacol 2015; 78:1257-63. [PMID: 25047693 DOI: 10.1111/bcp.12472] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 07/07/2014] [Indexed: 11/28/2022] Open
Abstract
Vitamin D is a particularly important sterol hormone and its effects beyond bone are increasingly recognized. Over the last decade clinical interest has grown in vitamin D, with increased recognition of deficiency and hence increased prescribing of vitamin D products. However, the increased prescription of vitamin D has generally been met with unlicensed vitamin D products which potentially expose the patient to clinical risk. This review discusses the issues relating to the clinical use of unlicensed vitamin D products, safety concerns that may arise from this, as well as discussing the medico-legal responsibilities of the prescriber and dispenser.
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Affiliation(s)
- John S Davies
- Department of Endocrinology, University Hospital of Wales, Cardiff, CF14 4XJ, UK
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Marins TA, Galvão TDFG, Korkes F, Malerbi DAC, Ganc AJ, Korn D, Wagner J, Guerra JCDC, Borges Filho WM, Ferracini FT, Korkes H. Vitamin D intoxication: case report. ACTA ACUST UNITED AC 2014; 12:242-4. [PMID: 25003934 PMCID: PMC4891171 DOI: 10.1590/s1679-45082014rc2860] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 12/09/2013] [Indexed: 11/30/2022]
Abstract
Hypervitaminosis D is a rarely reported condition. In general it is only perceived when hypercalcemia is not resolved. The use of vitamin D has increased in recent years because of its benefits, but as a result, intoxication cases have occurred more frequently. This report describes a patient who presented worsening of renal function and hypercalcemia. After investigation, vitamin D intoxication was confirmed and it was due to an error in compounding.
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Affiliation(s)
| | | | | | | | | | - Davi Korn
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Jairo Wagner
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | | | | | - Hélio Korkes
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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28
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van den Ouweland J, Fleuren H, Drabbe M, Vollaard H. Pharmacokinetics and safety issues of an accidental overdose of 2,000,000 IU of vitamin D3 in two nursing home patients: a case report. BMC Pharmacol Toxicol 2014; 15:57. [PMID: 25269374 PMCID: PMC4185191 DOI: 10.1186/2050-6511-15-57] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 09/25/2014] [Indexed: 12/16/2022] Open
Abstract
Background Administration of intermittent high doses of vitamin D3 is increasingly used as a strategy for rapid normalization of low 25-hydroxyvitamin D (25(OH)D) blood concentrations in patients with vitamin D deficiency. Here, we describe the pharmacokinetics of an accidental single oral overdose of 2,000,000 IU of vitamin D3 in two elderly nursing home patients and discuss safety issues. Case presentation Two patients, a Caucasian 90-year old man and a 95-year old woman, were monitored from 1 h up to 3 months after intake for clinical as well as biochemical signs of vitamin D intoxication. Blood vitamin D3 concentrations showed a prompt increase with the highest peak area already hours after the dose, followed by a rapid decrease to undetectable levels after day 14. Peak blood 25(OH)D3 concentrations were observed 8 days after intake (527 and 422 nmol/L, respectively (ref: 50–200 nmol/L)). Remarkably, plasma calcium levels increased only slightly up to 2.68 and 2.73 mmol/L, respectively (ref: 2.20–2.65 mmol/L) between 1 and 14 days after intake, whereas phosphate and creatinine levels remained within the reference range. No adverse clinical symptoms were noted. Conclusion A single massive oral dose of 2,000,000 IU of vitamin D3 does not cause clinically apparent toxicity requiring hospitalization, with only slightly elevated plasma calcium levels in the first 2 weeks. Toxicity in the long term cannot be excluded as annual doses of 500,000 IU of vitamin D3 for several years have shown an increase in the risk of fractures. This means that plasma calcium levels may not be a sensitive measure of vitamin D toxicity in the long term in the case of a single high overdose. To prevent a similar error in the future, the use of multiple-dose bottles need to be replaced by smaller single-unit dose formulations.
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Affiliation(s)
- Jody van den Ouweland
- Department of Clinical Chemistry, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ Nijmegen, The Netherlands.
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Ameratunga R, Crooks C, Simmons G, Woon ST. Health Risks and Adverse Reactions to Functional Foods. Crit Rev Food Sci Nutr 2014; 56:318-25. [DOI: 10.1080/10408398.2012.751895] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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30
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Benemei S, Gallo E, Giocaliere E, Bartolucci G, Menniti-Ippolito F, Firenzuoli F, Mugelli A, Vannacci A. It's time for new rules on vitamin D food supplements. Br J Clin Pharmacol 2014; 76:825-6. [PMID: 23594340 DOI: 10.1111/bcp.12134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 03/15/2013] [Indexed: 12/01/2022] Open
Affiliation(s)
- Silvia Benemei
- Department of Preclinical and Clinical Pharmacology, Centre of Molecular Medicine CIMMBA, Centre for Integrative Medicine, Florence University, Florence, Italy
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31
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Bell DA, Crooke MJ, Hay N, Glendenning P. Prolonged vitamin D intoxication: presentation, pathogenesis and progress. Intern Med J 2014; 43:1148-50. [PMID: 24134173 DOI: 10.1111/imj.12269] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 05/22/2013] [Indexed: 11/30/2022]
Abstract
Vitamin D toxicity from unactivated vitamin D (calciferol) therapy is currently a rare cause of hypercalcaemia. However, the frequency of this event may increase as high-dose unactivated vitamin D preparations become available. Prolonged vitamin D toxicity can cause reversible hypercalcaemia and partially reversible renal impairment. Parathyroid hormone may not be suppressed with unactivated vitamin D toxicity, especially if renal disease coexists.
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Affiliation(s)
- D A Bell
- Department of Core Clinical Pathology and Biochemistry, PathWest Laboratory Medicine WA, Royal Perth Hospital, Perth, Western Australia, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
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Amrein K, Quraishi SA, Litonjua AA, Gibbons FK, Pieber TR, Camargo CA, Giovannucci E, Christopher KB. Evidence for a U-shaped relationship between prehospital vitamin D status and mortality: a cohort study. J Clin Endocrinol Metab 2014; 99:1461-9. [PMID: 24423347 PMCID: PMC3973775 DOI: 10.1210/jc.2013-3481] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of the study was to examine the association between prehospital serum 25-hydroxyvitamin D [25(OH)D]and the risk of mortality after hospital admission. DESIGN We performed a retrospective cohort study of adults hospitalized for acute care between 1993 and 2011. SETTING The study was conducted at two Boston teaching hospitals. PATIENTS A total of 24,094 adult inpatients participated in the study. INTERVENTION There was no intervention. MEASUREMENTS All patients had serum 25(OH)D measured before hospitalization. The exposure of interest was 25(OH)D categorized as less than 10 ng/mL, 10-19.9 ng/mL, 20-29.9 ng/mL, 30-49.9 ng/mL, 50-59.9 ng/mL, 60-69.9 ng/mL, and 70 ng/mL or greater. The main outcome measure was 90-day mortality. Adjusted odds ratios (ORs) were estimated by multivariable logistic regression with inclusion of potential confounders. RESULTS After adjustment for age, gender, race (white vs nonwhite), patient type (surgical vs medical), season of 25(OH)D draw, and the Deyo-Charlson index, patients with 25(OH)D levels less than 30 ng/mL or 60 ng/mL or greater had higher odds of 90-day mortality compared with patients with levels of 30-49.9 ng/mL [adjusted OR (95% confidence interval) for 25(OH)D <10 ng/mL, 10-19.9 ng/mL, 20-29.9 ng/mL, 50-59.9 ng/mL, 60-69.9 ng/mL, and ≥70 ng/mL was 2.01 (1.68-2.40), 1.89 (1.64-2.18), 1.34 (1.16-1.56), 0.94 (0.69-1.26), 1.52 (1.03-2.25), and 1.69 (1.09-2.61), respectively, compared with patients with 25(OH)D levels 30-49.9 ng/mL]. LIMITATIONS A causal relationship between either low or high 25(OH)D levels and increased mortality can not necessarily be inferred from this observational study. CONCLUSIONS Analysis of 24 094 adult patients showed that 25(OH)D levels less than 20 ng/mL and 60 ng/mL or greater before hospitalization were associated with an increased odds of 90-day mortality. Although previous reports have suggested an association between low vitamin D status and mortality, these data raise the issue of potential harm from high serum 25(OH)D levels, provide a rationale for an upper limit to supplementation, and emphasize the need for caution in the use of extremely high doses of vitamin D among patients.
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Affiliation(s)
- Karin Amrein
- Division of Endocrinology and Metabolism (K.A.), Department of Internal Medicine, and Division of Endocrinology and Metabolism (T.R.P.), Department of Internal Medicine, Medical University of Graz, A-8036 Graz, Austria; Department of Anesthesia, Critical Care, and Pain Medicine (S.A.Q.), Division of Pulmonary and Critical Care Medicine (F.K.G.), Department of Medicine, and Department of Emergency Medicine (C.A.C.), Massachusetts General Hospital, Boston, Massachusetts 02114; Channing Division of Network Medicine and Pulmonary and Critical Care Division (A.A.L.), Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115; and Departments of Nutrition and Epidemiology (E.G.), Harvard School of Public Health, and The Nathan E. Hellman Memorial Laboratory (K.B.C.), Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115
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Vogiatzi MG, Jacobson-Dickman E, DeBoer MD. Vitamin D supplementation and risk of toxicity in pediatrics: a review of current literature. J Clin Endocrinol Metab 2014; 99:1132-41. [PMID: 24456284 DOI: 10.1210/jc.2013-3655] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
CONTEXT Although vitamin D toxicity is rare in children, increased use of vitamin D formulations, re-examination of optimal vitamin D levels, and use of higher doses lend potential for an increased incidence of vitamin D toxicity. EVIDENCE ACQUISITION A PubMed search was conducted through May 2013 for cases of vitamin D intoxication and vitamin D trials in pediatrics. Safety data were collected and reviewed. EVIDENCE SYNTHESIS A small number of pediatric studies tested vitamin D doses at or above the currently recommended upper tolerable intake. In children and adolescents, vitamin D excess was rare and usually asymptomatic. Recent cases of intoxication relate to errors in manufacturing, formulation, or prescription; involve high total intake in the range of 240,000 to 4,500,000 IU; and present with severe hypercalcemia, hypercalciuria, or nephrocalcinosis. However, mild hypercalcemia and hypervitaminosis using currently recommended doses have been reported in infants with rickets. CONCLUSIONS Although rare, cases of vitamin D intoxication that present with dramatic life-threatening symptoms still occur in children. Moreover, recent studies in infants raise a potential need for monitoring vitamin D levels when doses at or above the currently recommended upper range are used. Further studies are needed to clarify these findings. The Drugs and Therapeutics Committee of the Pediatric Endocrine Society suggests obtaining serum 25-hydroxyvitamin D levels in infants and children who receive long-term vitamin D supplementation at or above the upper level intake that is currently recommended.
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Affiliation(s)
- Maria G Vogiatzi
- Weill Cornell Medical College (M.G.V.), New York, New York 10065; SUNY Downstate Medical Center (E.J.-D.), Brooklyn, New York 11203; and University of Virginia Health System (M.D.D.), Charlottesville, Virginia 22908
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34
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Kara C, Gunindi F, Ustyol A, Aydin M. Vitamin D intoxication due to an erroneously manufactured dietary supplement in seven children. Pediatrics 2014; 133:e240-4. [PMID: 24298009 DOI: 10.1542/peds.2013-0711] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatric cases of vitamin D intoxication (VDI) with dietary supplements have not been previously reported. We report on 7 children with VDI caused by consumption of a fish oil supplement containing an excessively high dose of vitamin D due to a manufacturing error. Seven children aged between 0.7 and 4.2 years were admitted with symptoms of hypercalcemia. Initial median (range) serum concentrations of calcium and 25-hydroxyvitamin D were 16.5 (13.4-18.8) mg/dL and 620 (340-962) ng/mL, respectively. Repeated questioning of the parents revealed use of a fish oil that was produced recently by a local manufacturer. Analysis of the fish oil by gas chromatography/mass spectrometry revealed that the vitamin D3 content was ~4000 times the labeled concentration. Estimated daily amounts of vitamin D3 intake varied between 266,000 and 800,000 IU. Patients were successfully treated with intravenous hydration, furosemide, and pamidronate infusions. With treatment, serum calcium returned to the normal range within 3 days (range: 2-7 days). Serum 25-hydroxyvitamin D levels normalized within 2 to 3 months. Complications, including nephrocalcinosis, were not observed throughout the 1-year follow-up. In conclusion, errors in manufacturing of dietary supplements may be a cause of VDI in children. Physicians should be aware of this possibility in unexplained VDI cases and repeatedly question the families about dietary supplement use. To prevent the occurrence of such unintentional incidents, manufacturers must always monitor the levels of ingredients of their products and should be rigorously overseen by governmental regulatory agencies, as is done in the pharmaceutical industry.
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Affiliation(s)
- Cengiz Kara
- Division of Pediatric Endocrinology, Department of Pediatrics, Ondokuz Mayıs University, 55139, Kurupelit, Samsun, Turkey.
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Khadgawat R, Ramot R, Chacko KM, Marwaha RK. Disparity in cholecalciferol content of commercial preparations available in India. Indian J Endocrinol Metab 2013; 17:1100-1103. [PMID: 24381892 PMCID: PMC3872693 DOI: 10.4103/2230-8210.122638] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND High prevalence of vitamin D deficiency (VDD) has been reported throughout the India for all age groups. Increased awareness about VDD among treating physicians has led to increased prescriptions of vitamin D preparations. Based on our experience of varied clinical and radiological response with different vitamin D formulations, we decided to assess cholecalciferol content of commonly available vitamin D formulations. MATERIALS AND METHODS We measured cholecalciferol content of 14 commercial preparations (two in the form of tablets and 12 as sachet) available in Indian market. Lab analysis was carried out in Shriram Institute for Industrial Research by high-performance liquid chromatography. RESULTS Of the total 14 samples analyzed only 4 (28.57%) were found to be within the acceptable ranges from -90 to +125% as defined by Indian Pharmacopia while 5 (35.7%) had higher and 5 (35.7%) had lower than the acceptable range. The percentage variation in cholecalciferol content as observed from the printed ranged widely from -91% to +65%. CONCLUSIONS Our study shows a high degree of variability in cholecalciferol content of commercial preparations available in the Indian pharmaceutical market. This variation has many clinical implications as it may lead both, under treatment as well as vitamin D toxicity.
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Affiliation(s)
- Rajesh Khadgawat
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Rekha Ramot
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - K M Chacko
- Shri Ram Institute of Industrial Research, New Delhi, India
| | - R K Marwaha
- Shri Ram Institute of Industrial Research, New Delhi, India
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Abstract
OBJECTIVE Osteoporosis is a skeletal disorder characterized by diminished bone strength, which results in an increased risk of fracture. Currently, osteoporosis is a public health priority due to the large number of individuals affected and the detrimental effect on quality of life. Primary osteoporosis, the most common form, usually results from age-related reduction in bone mineral strength. Over time, the individual's capacity to build bone is impaired, as the synthesis of vitamin D, the hormone responsible for calcium absorption, tends to decline. As serum calcium levels decrease, metabolic control serves to increase the removal of calcium from the skeleton to make up for the deficit. The synthesis of the 'hormone' vitamin D and its control therefore become central to intervention in involutional osteoporosis syndromes. In humans, plain vitamin D (cholecalciferol), also called parental or native vitamin D, is photosynthesized in the skin and then hydroxylated in the liver into the vitamin D analog calcidiol [25(OH)D3], which is hydroxylated again in the kidney into the vitamin D analog calcitriol [1,25(OH)2D3]. The advantage of administering vitamin D analogs is that the pro-drug calcidiol avoids the effect of declines in hepatic function, while calcitriol avoids the effect of declines in hepatic and kidney function. A strategy to enhance [25(OH)D3] levels to the optimal threshold of vitamin D is supplementation with the calcidiol metabolite itself. The goal of this paper is to review published studies on the efficacy of the calcidiol metabolite in increasing 25(OH)D3 serum levels and improving skeletal health parameters in humans. METHODS A library search of published papers in the area of use of calcidiol in humans from 1967 to 2013 was performed (key words: calcidiol, 25-hydroxy-vitamin D3, vitamin D supplementation, vitamin D metabolism, osteomalacia). RESULTS AND CONCLUSION The results of the survey made it possible to conclude that calcidiol is characterized by a number of features that make the compound ideal in conditions that require supplementation with a 25-hydroxylated metabolite.
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Affiliation(s)
- Maria Luisa Brandi
- Department of Surgery and Translational Medicine, University of Florence , Italy
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37
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Maier JD, Levine SN. Hypercalcemia in the Intensive Care Unit: A Review of Pathophysiology, Diagnosis, and Modern Therapy. J Intensive Care Med 2013; 30:235-52. [PMID: 24130250 DOI: 10.1177/0885066613507530] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 07/13/2013] [Indexed: 02/02/2023]
Abstract
Hypercalcemia may be seen in a variety of clinical settings and often requires intensive management when serum calcium levels are dramatically elevated. All of the many etiologies of mild hypercalcemia can lead to severe hypercalcemia. Knowledge of the physiologic mechanisms involved in maintaining normocalcemia and basic pathophysiology is essential for making a timely diagnosis and hence prompt institution of etiology-specific therapy. The development of new medications and critical reviews of traditional therapies have changed the treatment paradigm for severe hypercalcemia, calling for a more limited role for aggressive isotonic fluid administration and furosemide and an expanded role for calcitonin and the bisphosphonates. Experimental therapies such as denosumab show promise.
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Affiliation(s)
- Joshua D Maier
- Department of Medicine, Section of Endocrinology and Metabolism, Overton Brooks Veterans Administration Medical Center, Shreveport, LA, USA
| | - Steven N Levine
- Department of Medicine, Section of Endocrinology and Metabolism, Louisiana State University Health Sciences Center, Shreveport, LA, USA
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Prietl B, Treiber G, Pieber TR, Amrein K. Vitamin D and immune function. Nutrients 2013; 5:2502-21. [PMID: 23857223 PMCID: PMC3738984 DOI: 10.3390/nu5072502] [Citation(s) in RCA: 628] [Impact Index Per Article: 57.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 06/24/2013] [Accepted: 06/25/2013] [Indexed: 02/06/2023] Open
Abstract
Vitamin D metabolizing enzymes and vitamin D receptors are present in many cell types including various immune cells such as antigen-presenting-cells, T cells, B cells and monocytes. In vitro data show that, in addition to modulating innate immune cells, vitamin D also promotes a more tolerogenic immunological status. In vivo data from animals and from human vitamin D supplementation studies have shown beneficial effects of vitamin D on immune function, in particular in the context of autoimmunity. In this review, currently available data are summarized to give an overview of the effects of vitamin D on the immune system in general and on the regulation of inflammatory responses, as well as regulatory mechanisms connected to autoimmune diseases particularly in type 1 diabetes mellitus.
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Affiliation(s)
- Barbara Prietl
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A 8036 Graz, Austria.
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Granado-Lorencio F, Blanco-Navarro I, Pérez-Sacristán B, Donoso-Navarro E, Silvestre-Mardomingo R. Serum levels of 3-epi-25-OH-D3 during hypervitaminosis D in clinical practice. J Clin Endocrinol Metab 2012; 97:E2266-70. [PMID: 23038681 DOI: 10.1210/jc.2012-2627] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Intoxication from vitamin D supplements has been rarely reported, but nowadays, it occurs more frequently. The presence of the C-3 epimer of 25-hydroxyvitamin D(3) (3-epi-25-OH-D(3)) is highly prevalent in adults, although there is little information regarding its in vivo relevance, if any, especially under pathological conditions. OBJECTIVE Our aim was to assess the presence of the 3-epi-25-OH-D(3) in serum samples displaying 25-OH-D(3) concentrations indicative of hypervitaminosis D. DESIGN, SETTING, PATIENTS, AND MAIN OUTCOME MEASURE A total of 58 samples displaying a wide range of concentrations of 25-OH-D(3) (>64-439 ng/ml) by ultrafast liquid chromatography were consecutively recruited and reassessed for the presence of 3-epi-25-OH-D(3) using a second chromatographic system. Data from additional biochemical tests performed as part of the patient evaluation were also recorded. RESULTS Mean relative contribution of 3-epi-25-OH-D(3) was less than 4%, and concentrations ranged from 2-28.6 ng/ml. Serum levels of the C3 epimer, but not the relative contribution, correlate with serum 25-OH-D(3). Overall, in subjects with 25-OH-D(3) concentrations indicative of hypervitaminosis D, the presence of the C-3 epimer and its levels were apparently unrelated to age, serum markers of renal and liver function, acute-phase reactants, and the presence of hypercalcemia. 3-Epi-25-OH-D(3) did not correlate with PTH, but subjects displaying PTH suppression (<14 pg/ml) showed higher concentrations of 3-epi-25-OH-D(3). CONCLUSION The relative contribution of 3-epi-25-D(3) was not significantly altered during hypervitaminosis D, although the absolute levels reached in serum may be biologically relevant. From a clinical viewpoint, although the small size of the group may affect the lack of relationships, the presence of 3-epi-25-OH-D(3) was apparently unrelated to serum markers of renal and liver function, acute-phase reactants, PTH, and the presence of hypercalcemia.
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Affiliation(s)
- F Granado-Lorencio
- Unidad de Vitaminas, Servicio de Bioquímica Clínica, Peine 7 (Planta 1), Hospital Universitario Puerta de Hierro-Majadahonda, c/ Joaquín Rodrigo, 2, 28222 Majadahonda, Spain.
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Abstract
OBJECTIVE Fat-soluble vitamin (FSV) deficiencies are common complications in pediatric patients with chronic cholestasis. The aim of the present study was to evaluate the status of FSV deficiencies in patients under present practice and to test the effect of an oral, absorbable, fat-soluble vitamin formulation (OAFSV) in these patients. METHODS We recruited a total of 23 pediatric patients receiving conventional FSV supplementation in a single medical center, with diagnosis of biliary atresia (10), progressive familial intrahepatic cholestasis (9), Alagille syndrome (2), and other conditions (2). Ten patients switched to OAFSV and continued for 3 months. Plasma levels of vitamins A, D, and E and an international normalized ratio (INR) for prothrombin time (PT), a surrogate marker for vitamin K deficiency, were measured. RESULTS The proportion of patients with FSV A, D, E, and K deficiencies under conventional supplementation was 73.9%, 81.8%, 91.3%, and 20.0%, respectively. In patients with total bilirubin levels ≥3.0 mg/dL, the proportion of at least 1 FSV deficiency was 100%; and the deficiency rates of vitamin A, D, E, and K were 78.6%, 100.0%, 100.0% and 21.4%, respectively. Of the 10 patients receiving standard daily dose of OAFSV for 3 months, no adverse events or overdose effects were found. The rates of vitamin A, D, and E deficiency in the patients receiving OAFSV decreased from 80.0%, 100%, and 100%, respectively, to 70.0%, 60.0%, and 60.0% after 3 months of oral supplementation. CONCLUSIONS High rates of FSV deficiency were found in pediatric patients with chronic cholestasis under present follow-up. OAFSV supplementation is safe and potentially effective in pediatric patients with cholestasis.
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Demetriou ETW, Travison TG, Holick MF. Treatment with 50,000 IU vitamin D₂ every other week and effect on serum 25-hydroxyvitamin D₂, 25-hydroxyvitamin D₃, and total 25-hydroxyvitamin D in a clinical setting. Endocr Pract 2012; 18:399-402. [PMID: 22440989 DOI: 10.4158/ep11268.or] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To examine the effect of 50,000 IU-vitamin D₂ supplementation in a clinical setting on serum total 25-hydroxyvitamin D (25[OH]D), 25-hydroxyvitamin D₂ (25[OH]D₂), and 25-hydroxyvitamin D3 (25[OH]D₃). METHODS This retrospective cohort study was performed in an urban tertiary referral hospital in Boston, Massachusetts. Patients who had been prescribed 50,000 IU vitamin D₂ repletion and maintenance programs were identified through a search of our electronic medical record. Baseline and follow-up total serum 25(OH)D, 25(OH)D₂, and 25(OH)D₃ levels were compared. RESULTS We examined the medical records of 48 patients who had been prescribed 50,000 IU vitamin D₂ in our clinic. Mean ± standard deviation baseline total 25(OH)D was 31.0 ± 10.6 ng/mL and rose to 48.3 ± 13.4 ng/mL after treatment (P<.001). 25(OH)D₂ increased from 4.2 ± 4.3 ng/mL to 34.6 ± 12.3 ng/mL after treatment (P<.001), for an average of 158 days (range, 35-735 days). Serum 25(OH)D₃ decreased from 26.8 ± 10.8 ng/mL to 13.7 ± 7.9 ng/mL (P<.001). CONCLUSIONS Fifty thousand IU vitamin D₂ repletion and maintenance therapy substantially increases total 25(OH)D and 25(OH)D₂ despite a decrease in serum 25(OH)D₃. This treatment program is an appropriate and effective strategy to treat and prevent vitamin D deficiency.
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Affiliation(s)
- Emily T W Demetriou
- Section of Endocrinology and Diabetes, Maine Medical Center, Portland, Maine, USA
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McKeag NA, McKinley MC, Woodside JV, Harbinson MT, McKeown PP. The role of micronutrients in heart failure. J Acad Nutr Diet 2012; 112:870-86. [PMID: 22709814 DOI: 10.1016/j.jand.2012.01.016] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 01/19/2012] [Indexed: 02/07/2023]
Abstract
Heart failure is a common condition in the Western world, particularly among elderly persons and with an ever-aging population, the incidence is expected to increase. Diet in the setting of heart failure is important--patients with this condition are advised to consume a low-salt diet and monitor their weight closely. Nutritional status of patients with heart failure also is important--those with poor nutritional status tend to have a poor long-term prognosis. A growing body of evidence suggests an association between heart failure and micronutrient status. Reversible heart failure has been described as a consequence of severe thiamine and selenium deficiency. However, contemporary studies suggest that a more subtle relationship may exist between micronutrients and heart failure. This article reviews the existing literature linking heart failure and micronutrients, examining studies that investigated micronutrient intake, micronutrient status, and the effect of micronutrient supplementation in patients with heart failure, and focusing particularly on vitamin A, vitamin C, vitamin E, thiamine, other B vitamins, vitamin D, selenium, zinc, and copper.
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Affiliation(s)
- Nicholas A McKeag
- Centre for Public Health, Queen’s University Belfast, Institute of Clinical Science B, Belfast, United Kingdom.
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Granado-Lorencio F, Rubio E, Blanco-Navarro I, Pérez-Sacristán B, Rodríguez-Pena R, García López F. Hypercalcemia, hypervitaminosis A and 3-epi-25-OH-D3 levels after consumption of an “over the counter” vitamin D remedy. A case report. Food Chem Toxicol 2012; 50:2106-8. [DOI: 10.1016/j.fct.2012.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 03/01/2012] [Accepted: 03/01/2012] [Indexed: 10/28/2022]
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Abstract
PURPOSE OF REVIEW To summarize the current knowledge on vitamin D with a special focus on critically ill patients. RECENT FINDINGS Vitamin D deficiency is associated with adverse health outcomes including increased risk of cardiovascular disease, morbidity and mortality in the general population. In critically ill patients, the pleiotropic effects of vitamin D including its role in immune function are of great interest. SUMMARY To date, it is not clear whether vitamin D deficiency is a surrogate marker for increased morbidity or whether treatment with sufficiently large doses of vitamin D may improve patient outcome in an intensive care setting.
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Affiliation(s)
- Karin Amrein
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Austria.
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de Paula FJA, Rosen CJ. Vitamin D safety and requirements. Arch Biochem Biophys 2011; 523:64-72. [PMID: 22179017 DOI: 10.1016/j.abb.2011.12.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 11/30/2011] [Accepted: 12/02/2011] [Indexed: 12/22/2022]
Abstract
Vitamin D an ancient secosteroid is essential for mineral homeostasis, bone remodeling, immune modulation, and energy metabolism. Recently, debates have emerged about the daily vitamin D requirements for healthy and elderly adults, the safety and efficacy of long term supplementation and the role of vitamin D deficiency in several chronic disease states. Since this molecule acts as both a vitamin and a hormone, it should not be surprising that the effects of supplementation are multi-faceted and complex. Yet despite significant progress in the last decade, our understanding of vitamin D physiology and the clinical relevance of low circulating levels of this vitamin remains incomplete. The present review provides the reader with a comprehensive and up-to-date understanding of vitamin D requirements and safety. It also raises some provocative research questions.
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Affiliation(s)
- Francisco J A de Paula
- Department of Internal Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, 14049-900 SP, Brazil.
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