The other side of vitamin D therapy: a case series of acute kidney injury due to malpractice-related vitamin D intoxication

摘要

Background: Vitamin D deficiency is highly prevalent in Indian Kashmir. Many people get injectable vitamin D (600,000 IU/injection). At times, the dose prescribed is far above the permissible limit. We report 62 patients with malpractice-related vitamin D intoxication, presenting with hypercalcemia and acute kidney injury (AKI). Methods: The diagnosis was made on basis of (1) history of multiple intramuscular vitamin D injections (2) toxic serum levels of 25-OH vitamin D and (3) exclusion of common causes of hypercalcemia (malignancy and hyperparathyroidism). Their presentation was either de novo AKI in 51 (group 1) or acute on top of chronic kidney disease in 11 (group 2). Results: The mean age was 60 +/- 14 vs. 62 +/- 13 years, approximate number of vitamin D injections received ranged from 4 to 28 (2.4-16.8 million units) vs. 3 to 24 (1.8-14.4 million units), mean creatinine at presentation was 3.2 +/- 0.9 vs. 4.5 +/- 1.1 mg/dL, which decreased to 1.2 +/- 0.2 vs. 3.3 +/- 1.0 mg/ dL, mean serum calcium on admission was 13.7 +/- 1.4 vs. 13.6 +/- 2.0 mg/dL which decreased to 10.7 +/- 1.2 vs. 11.0 +/- 1.0 mg/dL on follow-up of 7.2 +/- 0.6 months, mean vitamin D level was 313.3 +/- 54.8 (range 235-375) vs. 303.7 +/- 48.4 (range 210-375) nmol/L and mean PTH was 18.1 +/- 9.6 (range 6.2-32) vs. 52.3 +/- 12.6 (range 28-88) pg/mL in group 1 vs. group 2, respectively. The clinical presentation was weakness, constipation, abdominal pain, nausea, vomiting, anorexia, altered sensorium, and oliguria. The treatment received was intravenous fluids (normal saline) in all in group 1 and in 8/11 in group 2, short course of steroids (prednisolone) in 44, and bisphosphonate in 6. Conclusion: This is the largest case series of AKI secondary to vitamin D toxicity ever reported.