SHM Converge Scientific Abstract ePoster Gallery-Severe Hypercalcemia and Acute Kidney Injury From Extreme Vitamin D Supplementation: A Modern Toxicity in Hospital Medicine

Severe Hypercalcemia and Acute Kidney Injury From Extreme Vitamin D Supplementation: A Modern Toxicity in Hospital Medicine

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This case report describes a 68-year-old man who developed severe hypercalcemia and acute kidney injury after taking extreme over-the-counter vitamin D and calcium supplements. He presented with a month of nausea, vomiting, abdominal pain, fatigue, constipation, anorexia, and 20-lb weight loss. Initial evaluation showed markedly elevated creatinine (5.24 mg/dL) and persistent hypercalcemia, with imaging suggesting high intraluminal calcium content. A detailed supplement history revealed he had been taking 14 tablets daily of calcium carbonate-vitamin D, totaling about 150,000 IU/day of vitamin D and 1,200 mg/day of calcium carbonate for several weeks.<br /><br />Treatment began with aggressive IV isotonic fluids and loop diuretics, but calcium remained elevated. Prednisone 40 mg/day was added on hospital day 2–3 to reduce intestinal calcium absorption, after which symptoms improved over the next several days and calcium levels gradually normalized. Kidney function also improved, with creatinine falling to about 2.4 mg/dL before discharge. He was sent home on a prednisone taper, counseled on safe supplement use, and arranged for nephrology and primary care follow-up.<br /><br />The report emphasizes that vitamin D toxicity is uncommon but increasingly encountered because high-dose supplements are easily accessible. Because vitamin D is fat-soluble and has a long half-life, toxicity can cause prolonged metabolic disturbance. Key diagnostic clues include suppressed PTH, markedly elevated 25-OH vitamin D, and a history of excessive supplementation. The authors stress that a targeted supplement history is a high-yield, often underused diagnostic step. Management starts with fluids and loop diuretics, but glucocorticoids may be necessary when hypercalcemia persists.

Asset Subtitle

Arjune S. Nibber

Meta Tag

Author List Arjune S. Nibber, Tarlan Moini Zandi

Category Clinical Vignettes

Concept Vitamin D Excess

Concept Hypercalcemia

Concept Acute Kidney Injury

Concept Parathyroid Hormone

Concept Serum 25-Hydroxyvitamin D

Distinguished Non-Finalist

Presenter Organization UC San Diego Health

Presenting Author Arjune S. Nibber

Track Adult

Keywords

vitamin D toxicity

hypercalcemia

acute kidney injury

calcium carbonate

supplement overdose

prednisone

glucocorticoids

supplement history

nephrology

25-OH vitamin D

Vitamin D Excess

Hypercalcemia

Acute Kidney Injury

Parathyroid Hormone

Serum 25-Hydroxyvitamin D