Self-administration of vitamin D supplements in the general public may be associated with high 25-hydroxyvitamin D concentrations.

Introduction Our dried blood spot vitamin D testing service enables members of the public to assess their vitamin D status. Vitamin D has become popular with the media and the general public. We noticed that our direct access service had a higher rate of high to toxic 25-hydroxyvitamin D levels compared with our GP population and we wanted to know why. Methods Between January 2013 and September 2015 we contacted all direct access users who had 25-hydroxyvitamin D >220 nmol/L measured using LC/MS/MS. We investigated the amount, type and length of supplementation used and whether or not users were medically supervised. Results A total of 372 service users had 25-hydroxyvitamin D concentrations >220 nmol/L. Of 14,806 direct access samples received, 372 (2.5%) were from users with 25-hydroxyvitamin D concentrations ranging from 221 to 1235 nmol/L. Only 0.06% of GP patients had results >220 nmol/L over the same time frame. There were 361 direct access users regularly supplementing, taking between 1000 to 120,000 IU/day. Two users took bolus doses of 300,000 and 900,000 IU. Only 23 users taking supplements (6.4%) were under medical supervision. There were 28 users with levels >500 nmol/L, but only one was under medical supervision. The internet was the main source of supplements (74%). Conclusions The proportion of high to toxic concentrations of vitamin D was higher in direct access users than in the GP population. Many people were taking more than the Institute of Medicine's recommendation of 10,000 IU/day, yet only a few were being medically supervised. Clinicians should be aware that patients may be self-administering very high concentrations of vitamin D, especially when investigating unexplained hypercalcaemia.

Analysis of legal high materials by ultra-performance liquid chromatography with time of flight mass spectrometry as part of a toxicology vigilance system: what are the most popular novel psychoactive substances in the UK?

Introduction Legal highs also known as novel psychoactive substances mimic the effects of classic drugs of abuse. Challenges to developing screening services for novel psychoactive substances include identifying which novel psychoactive substances are available to target. Using new techniques such as exact mass time of flight can help identify common novel psychoactive substances to target for screening patient samples by routine methods such as tandem mass spectrometry. We demonstrate this strategy working in our own clinical toxicology laboratory after qualitative analysis of 98 suspect materials for novel psychoactive substances by ultra-performance liquid chromatography with time of flight mass spectrometry. Results From July 2014 to July 2015 we received 98 requests to test a range of different suspect materials for novel psychoactive substances including herbs, tobacco, liquids, pills and powders. Overall, 87% of the suspect materials tested positive for novel psychoactive substances, and 15% for controlled drugs. Three common novel psychoactive substances were present in 74% of the suspect materials: methiopropamine, a methamphetamine analogue; ethylphenidate, a cocaine mimic; and the third generation synthetic cannabinoid 5F-AKB-48. For the 55 branded products we tested only 24% of the stated contents matched exactly the compounds we detected. Conclusion Testing suspect materials using ultra-performance liquid chromatography with time of flight mass spectrometry has identified three common novel psychoactive substances in use in the UK, simplifying the development of a relevant novel psychoactive substances screening service to our population. By incorporating this into our routine liquid chromatography tandem mass spectrometry drugs of abuse screen, then offers a clinically relevant novel psychoactive substances service to our users. This strategy ensures our clinical toxicology service continues to remain effective to meet the challenges of the changing drug use in the UK.