Abstract: TH-PO0233
Successful Treatment of Soladek-Associated Vitamin D Intoxication with Plasmapheresis in a Patient with ESRD
Session Information
- Bone and Mineral Metabolism: Clinical Reports and Practice
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 502 Bone and Mineral Metabolism: Clinical
Authors
- Sedlacek, Martin, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Da Silva Lugo, Ian J., Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Sonti, Pujitha, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Chung, Miriam, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Uribarri, Jaime, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Kim, Tonia K., Icahn School of Medicine at Mount Sinai, New York, New York, United States
Introduction
Soladek is an over the counter vitamin supplement that greatly exceeds daily allowances and has an FDA warning. A previous HPLC indicated that each vial contains 864,000IU of cholecalciferol. Herein we present a dialysis patient who suffered severe intractable hypercalcemia and extremely high vitamin D levels related to Soladek.
Case Description
A 64 y/o woman with ESRD secondary to lupus nephritis and feeding tube after esophagectomy for cancer presented with profound fatigue, nausea and severe headaches. She had severe hypercalcemia 14.1mg/dl after taking three weekly dose vials of Soladek. Ionized calcium was 1.78mmol/L, PTH 148pg/ml, PTHrP undetectable, IFE normal, 25 Vitamin D >154ng/ml, Calcitriol 549pg/ml, albumin 3.5g/dl, phosphorus 6.5mg/dl. The previous monthly calcium in her dialysis labs had been normal. She required 7 dialysis treatments with low calcium dialysate in the next 9 days to control her serum calcium because of symptomatic rebound to 11-14mg/dl. Due to intractable hypercalcemia, plasmapheresis was added to remove vitamin D in conjunction with ongoing hemodialysis. The patient received 5 plasmapheresis treatments of one plasma volume exchange against 5% albumin, citrate dextrose anticoagulation without prophylactic calcium gluconate. Vitamin D levels decreased (figure1), serum calcium levels normalized and the patient was discharged after 4 weeks.
Discussion
This patient presented with severe vitamin D intoxication with intractable hypercalcemia. Because of lipophilicity and protein binding Vitamin D is not removed by conventional hemodialysis whereas plasmapheresis removes vitamin D binding protein and can cause vitamin D deficiency. In a previous case report from Germany plasmapheresis was used successfully for vitamin D intoxication. Although Vitamin D overdose is not explicitly mentioned in ASFA guidelines a decision was made to treat this patient with plasmapheresis which resulted in resolution of hypercalcemia and vitamin D toxicity.