ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: SA-PO511

Severe Hypercalcemia due to Hypervitaminosis D

Session Information

Category: Fluid‚ Electrolyte‚ and Acid-Base Disorders

  • 1002 Fluid‚ Electrolyte‚ and Acid-Base Disorders: Clinical

Authors

  • Lohano, Kuldeep, Texas Tech University Health Sciences Center, Lubbock, Texas, United States
  • Prabhakar, Sharma S., Texas Tech University Health Sciences Center, Lubbock, Texas, United States
Introduction

Hypercalcemia is not an uncommon clinical problem but hypervitaminosis D causing hypercalcemia in very uncommon. We are reporting a patient who presented with this unusual condition.

Case Description

A 71 year old frail Caucasian male, presented to ER secondary to a fall. The past medical history was significant for coronary heart disease, hypertension, CHF, COPD, rheumatoid arthritis (on prednisone), right femoral fracture and no history of CKD. A CT scan with contrast on admission revealed a left intertrochanteric fracture and multiple vertebral fractures. On admission, laboratory studies were remarkable for hypercalcemia (14.2 mg/dl), HB: 12.9 g, platelet count of 446k and lWBC count of 33k. Serum Cr was 0.9 mg/dl,albumin 3.9 g/dl, and, BUN: 39 mg/dl. On examination, patient was hypovolemic, confused, chronic RA changes in hands. Diagnostic work up was negative for Multiple myeloma and malignancy. Further interrogation revealed a history of of high dose of vitamin D (10,000 iu daily) for a long period which correlated with a vitamin D level of 200 ng/ml and PTH of 16 pg/ml. He was started on IV fluids and calcitonin and furosemide. The hypercalcemia improved on 3rd day while renal function continued to worsen after second day (Scr 1.3 to 2.0 mg/dl) possibly due to contrast induced renal injury. Subsequent course in the hospital was notable for return of calcium levels to 9.5mg/dl and improving renal function on discharge.

Discussion

The purpose for reporting this case is two-fold. 1. Vitamin D is rare cause of hypercalcemia, often resulting from prolonged over consumption of vitamin D and calcium supplements without monitoring the serum levels. 2. Consequences of hypercalcemia include dehydration, risk of acute kidney injury, and increased risk of bone fracture. The cause of hypercalcemia in this patient initially was not obvious as hyperparathyroidism, malignancy (multiple myeloma), hyper-thyroidism and adrenal insufficiency were excluded but finally it was narrowed down to hyper-vitaminosis D. Initial hemoconcentration due to hypovolemia, was confirmed by normalization of many lab abnormalities after IV fluids. Hypercalcemia could be a contributory factor to AKI (caused by the radio-contrast) as well as to bone fracture by decreased bone turn over due to low PTH and cumulative steroid use. To conclude this case exemplifies how hypercalcemia can result from an usual cause and lead to multiple complications.