ABSTRACT
Background: the population in Latin America is aging and elders face several obstacles for good health, including an elevated frequency of vitamin D deficiency. Thus, identification of patients at high risk to develop its negative consequences should be a priority. Objective: the objective of this analysis was to determine if levels of vitamin D lower than 15 ng/ml are associated with high mortality in Mexican elderly population, from the database of the Mexican Health and Aging Study (MHAS). Methods: prospective, population study in Mexico, that included Subjects of 50 years and older who were evaluated for Serum vitamin D levels during the year 2012 (third wave of the study). Serum 25(OH)D levels were categorized into four groups, based on cutoff points used in previous studies on vitamin D and frailty: < 15, 15-< 20, 20-< 30 and ≥ 30 ng/ml. Mortality was evaluated during 2015 (fourth wave of the study). Hazard ratio was calculated (for mortality) through Cox Regression Model, adjusted for covariates. Results: we included 1626 participants, and those with lower levels of vitamin D were older, more often women, required more aid for activities of daily living, reported higher number of chronic diseases, and lower scores on cognition. The relative risk of death was 5.421 (95 % CI 2.465-11.92, p < 0.001) for the participants with vitamin D levels < 15, which after adjusting for covariates, remained statistically significant. Conclusions: levels of vitamin D lower of 15, are associated with an increase in the rate of mortality in community-dwelling senior Mexicans.(AU)
Introducción: la población en América Latina está envejeciendo y los adultos mayores enfrentan varios obstáculos para gozar de buena salud,incluida una frecuencia elevada de deficiencia de vitamina D. Por lo tanto, la identificación de pacientes con alto riesgo de desarrollar susconsecuencias negativas debe ser una prioridad.Objetivo: el objetivo de este análisis fue determinar si los niveles de vitamina D inferiores a 15 ng/ml están asociados con una alta mortalidaden la población adulta mayor mexicana, a partir de la base de datos del Estudio de Salud y Envejecimiento en México.Métodos: estudio poblacional prospectivo en México, que incluyó Sujetos de 50 años y mayores que fueron evaluados para los niveles de vitaminaD en suero durante el año 2012 (tercera ola del estudio). Los niveles séricos de 25(OH)D se clasificaron en cuatro grupos, según los puntos decorte utilizados en estudios previos sobre vitamina D y fragilidad: < 15, 15-< 20, 20-< 30 y ≥ 30 ng/ml. La mortalidad se evaluó durante 2015(cuarta ola del estudio). Se calculó la razón de riesgo (para la mortalidad) a través del modelo de regresión de Cox, ajustado por covariables.Resultados: incluimos 1626 participantes, y aquellos con niveles más bajos de vitamina D eran mayores, más a menudo mujeres, requerían másayuda para las actividades de la vida diaria, informaron un mayor número de enfermedades crónicas y puntuaciones más bajas en cognición. Elriesgo relativo de muerte fue de 5,421 (IC 95 % 2,465-11,92, p < 0,001) para los participantes con niveles de vitamina D < 15, que despuésde ajustar por covariables, se mantuvo estadísticamente significativo.Conclusiones: niveles de vitamina D inferiores a 15, se asocian con un aumento en la tasa de mortalidad en adultos mayores mexicanosresidentes en la comunidad.(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aging , Vitamin D/administration & dosage , Vitamin D/toxicity , Mortality , Mexico , Prospective StudiesABSTRACT
A intoxicação por vitamina D era pouco frequente no Brasil até seu crescente uso na última década. Neste artigo relatamos um caso de intoxicação por vitamina D em que houve a prescrição intencional de dose muito superior ao recomendado pela literatura, com a finalidade de prevenir doenças via "modulação hormonal". A paciente em questão, idosa, previamente hígida, foi submetida a um tratamento não regulamentado e sem respaldo científico, que culminou em sintomas como náuseas e vômitos, além de perda de peso, inapetência, poliúria e astenia ao longo dos meses. Através da história e exames laboratoriais foi diagnosticada intoxicação por vitamina D e lesão renal aguda. Após o tratamento houve remissão completa dos sintomas. A "modulação hormonal" é uma prática condenada pelos Conselhos Federais de Medicina e Odontologia e pela Sociedade Brasileira de Endocrinologia e Metabologia. O ato de prescrever é de grande responsabilidade ética e técnica e deve ser embasado em evidências científicas, oferecendo o melhor tratamento possível aos pacientes, seja ele preventivo ou curativo, minimizando riscos e danos, respeitando as recomendações das autoridades competentes. (AU)
Vitamin D poisoning was not frequent in Brazil until its increasing use in the last decade. In this article, we report a case of intoxication by intentional prescription of vitamin D in a much higher dose than the literature recommends, in order to prevent diseases via "hormonal modulation". The case described in this report was an elderly woman, previously healthy patient that was submitted to an unregulated treatment without scientific support, leading to symptoms such as nausea and vomiting, in addition to weight loss, lack of appetite, polyuria and asthenia over the months. Through the history and laboratory testing, vitamin D intoxication and acute kidney injury were diagnosed. After treatment, there was a complete remission of the symptoms. "Hormonal modulation" is a practice condemned by the Federal Councils of Medicine and Dentistry and by the Brazilian Society of Endocrinology and Metabology. The act of prescribing is of great ethical and technical responsibility and it must be based on scientific evidence. Thus, the patient can receive the best possible treatment, for either preventive or curative nature, by respecting the recommendations of the competent authorities and, therefore, minimizing risks and damages to patients. (AU)
Subject(s)
Humans , Female , Aged , Polyuria , Asthenia , Vitamin D/toxicity , Weight Loss , Anorexia , Ethics, Professional , Acute Kidney InjuryABSTRACT
Vitamin D toxicity is associated with accidental overdoses due to manufacturing or intake errors and its secondary hypercalcemia can result in severe morbidity. Although patients with cystic fibrosis are potentially at increased risk for this intoxication as prescription of vitamin D preparations is a common practice in this population, the frequency of such events is currently unknown. We performed a retrospective analysis of all the files of cystic fibrosis patients followed at the Cliniques universitaires Saint-Luc over a 10-year period, recording 25(OH)- and 1,25(OH)2vitamin D levels as well as demographic data, lung function tests, Pseudomonas aeruginosa infection and results from pharmacological analysis of magistral liposoluble vitamins preparations. A total of 244 patients were included in the study. 13 patients (5%) had serum vitamin D levels corresponding to vitamin D overdose. Patients who had experienced an overdose were more likely to be F508del homozygous or suffer from exocrine pancreatic insufficiency. 2 patients developed significant hypercalcemia necessitating monitoring and hospitalization. Errors in the preparation of magistral liposoluble vitamin pills were identified in several intoxicated patients. Retrospective assessment of the dosing errors with the local pharmacists showed that trituration and dosing errors were their most frequent causes.
Subject(s)
Cystic Fibrosis/complications , Drug Overdose/complications , Vitamin D/toxicity , Adolescent , Adult , Cohort Studies , Cystic Fibrosis/physiopathology , Female , Humans , Male , Medication Errors , Retrospective Studies , Vitamin D/analogs & derivatives , Vitamin D/blood , Young AdultABSTRACT
This Research Reflection short review will discuss vitamin D metabolism, its role in nutrition, disease prevention, and welfare of dairy cattle, as well as its toxicity. Vitamin D is an important fat-soluble vitamin. However, some researchers regard it as a hormone due to its function in the organism. Its role is not limited just to Ca homoeostasis and bone metabolism but is also associated with immunity. In dairy cattle it is known for preventing milk fever. Cows can acquire vitamin D in many ways for example through feed, parenteral injections or through UVB irradiation from the sun or artificial lighting. The vitamin D in feed can either be plant-/ fungi- based ergocalciferol or animal-based cholecalciferol. There is currently only one registered feed vitamin D supplement for cattle in the European Union and it is cholecalciferol. Animals can also synthesize their own vitamin D when 7-dihydrocholesterol in the skin is irradiated with UVB light resulting in cholecalciferol production. Despite its importance, many cattle are deficient in vitamin D due to inadequate supplementation or insufficient sun exposure. In a study performed at the Veterinary Faculty in Slovenia 12 high producing Holstein Friesian cows at a commercial dairy farm were blood tested for vitamin D status for three succeeding months and all but one were vitamin D insufficient in all testings. The cows were not exposed to direct sunlight and the content of vitamin D3 in feed was <400 IU/kg dry matter, which is less than half of the NRC (2001) recommendation. Deficiency can also occur due to diseases affecting the gastrointestinal tract, such as paratuberculosis, which lower the absorptive capacity of the gut. Vitamin D can be toxic if cows are over-supplemented or consume large quantities of plants like Trisetum flavescens, which contain an active form of vitamin D-calcitriol or its glycosides, that are activated by digestion in the rumen.
Subject(s)
Cattle/physiology , Dairying , Health Status , Vitamin D/physiology , Animal Feed/analysis , Animal Welfare , Animals , Cattle Diseases/prevention & control , Cholecalciferol/administration & dosage , Dietary Supplements , European Union , Female , Lactation , Skin/metabolism , Sunlight , Vitamin D/administration & dosage , Vitamin D/toxicity , Vitamin D Deficiency/veterinaryABSTRACT
Abstract Fortification of food products with vitamin D was central to the eradication of rickets in the early parts of the 20th century in the United States. In the subsequent almost 100 years since, accumulating evidence has linked vitamin D deficiency to a variety of outcomes, and this has paralleled greater public interest and awareness of the health benefits of vitamin D. Supplements containing vitamin D are now widely available in both industrialized and developing countries, and many are in the form of unregulated formulations sold to the public with little guidance for safe administration. Together, this has contributed to a transition whereby a dramatic global increase in cases of vitamin D toxicity has been reported. Clinicians are now faced with the challenge of managing this condition that can present on a spectrum from asymptomatic to acute life-threatening complications. This article considers contemporary data on vitamin D toxicity, and diagnostic and management strategies relevant to clinical practice.
Resumo A suplementação de produtos alimentares com vitamina D foi fundamental para a erradicação do raquitismo no início do século XX nos Estados Unidos. Nos quase 100 anos subsequentes, o acúmulo de evidências vinculou a deficiência de vitamina D a uma variedade de desfechos, e isso tem levantado grande interesse público e conscientização dos benefícios à saúde da vitamina D. Os suplementos que contêm vitamina D estão agora amplamente disponíveis tanto nos países desenvolvidos quanto naqueles em desenvolvimento, e muitos estão na forma de formulações não regulamentadas, vendidas ao público com poucas orientações para uma administração segura. Juntos, isso contribuiu para uma transição na qual um aumento global dramático nos casos de toxicidade da vitamina D tem sido relatado. Médicos agora enfrentam o desafio de tratar essa condição que pode apresentar um espectro de complicações assintomáticas a agudas, com risco de vida. Este artigo considera dados atualizados sobre a toxicidade da vitamina D e estratégias de diagnóstico e manejo relevantes para a prática clínica.
Subject(s)
Humans , Male , Aged , Rickets/prevention & control , Vitamin D/toxicity , Dietary Supplements/toxicity , Acute Kidney Injury/chemically induced , Rickets/epidemiology , Vitamin D Deficiency/complications , Vitamin D Deficiency/drug therapy , Treatment Outcome , Dietary Supplements/supply & distribution , Withholding Treatment , Acute Kidney Injury/therapy , Hypercalcemia/complications , Hypercalcemia/diagnosis , Hypercalcemia/chemically induced , Hypercalcemia/therapyABSTRACT
Fortification of food products with vitamin D was central to the eradication of rickets in the early parts of the 20th century in the United States. In the subsequent almost 100 years since, accumulating evidence has linked vitamin D deficiency to a variety of outcomes, and this has paralleled greater public interest and awareness of the health benefits of vitamin D. Supplements containing vitamin D are now widely available in both industrialized and developing countries, and many are in the form of unregulated formulations sold to the public with little guidance for safe administration. Together, this has contributed to a transition whereby a dramatic global increase in cases of vitamin D toxicity has been reported. Clinicians are now faced with the challenge of managing this condition that can present on a spectrum from asymptomatic to acute life-threatening complications. This article considers contemporary data on vitamin D toxicity, and diagnostic and management strategies relevant to clinical practice.
Subject(s)
Acute Kidney Injury/chemically induced , Dietary Supplements/toxicity , Rickets/prevention & control , Vitamin D/toxicity , Acute Kidney Injury/therapy , Aged , Dietary Supplements/supply & distribution , Humans , Hypercalcemia/chemically induced , Hypercalcemia/complications , Hypercalcemia/diagnosis , Hypercalcemia/therapy , Male , Rickets/epidemiology , Rickets/etiology , Treatment Outcome , Vitamin D/adverse effects , Vitamin D/therapeutic use , Vitamin D Deficiency/complications , Vitamin D Deficiency/drug therapy , Withholding TreatmentABSTRACT
As aging progresses, there is a consequent increase in chronic diseases, such as osteoporosis and osteopenia, and vitamin D (cholecalciferol) supplementation is routinely prescribed. However, indiscriminate use of this supplement can lead to intoxication and systemic changes. Seeking to raise awareness among prescribing physicians and especially older patients, the purpose of this case report was to describe the systemic symptoms and damage that can occur from intoxication due to uncontrolled use of vitamin D, such as hypercalcemia and kidney injury. This report describes the case of an older woman who reported using a cholecalciferol- containing formula for ten years to treat osteoarthritis. She arrived at the hospital with weight loss, acute kidney injury and hypercalcemia. After ruling out neoplastic diseases, she was diagnosed with vitamin D poisoning. The symptoms and laboratory results improved after treatment. Based on this report, we conclude that geriatricians play a key role in demystifying the use of vitamins and should only prescribe them when medically indicated.
Com a progressão do envelhecimento e, consequentemente, o aumento de doenças crônicas, como osteoporose e osteopenia, a suplementação da vitamina D (colecalciferol) tem sido rotineiramente prescrita, no entanto o uso indiscriminado e o não controle dessa reposição podem levar à intoxicação e, consequentemente, a alterações sistêmicas. Buscando conscientizar médicos prescritores, e principalmente pacientes idosos, o objetivo do relato do caso foi de alertar sobre o uso desregrado e divulgar os diversos sintomas sistêmicos, além dos danos dessa intoxicação, como hipercalcemia e lesão renal. Este relato trata do caso de uma idosa que afirmava usar fórmula contendo colecalciferol há dez anos para tratar osteoartrite. Chegou ao hospital com emagrecimento, lesão renal aguda e hipercalcemia. Após descartar doenças neoplásicas, foi diagnosticada com intoxicação de vitamina D. Feito tratamento, houve remissão sintomatológica e laboratorial. Com base nesse relato, concluímos que o geriatra tem um papel fundamental de desmistificar o uso de vitaminas e prescrever estritamente quando há indicação médica.
Subject(s)
Humans , Female , Aged, 80 and over , Vitamin D/adverse effects , Vitamin D/toxicity , Hypercalcemia/complications , Self Medication/adverse effects , Acute Kidney Injury/chemically induced , Hypercalcemia/rehabilitationABSTRACT
Poor vitamin D status is associated with a higher relapse rate and earlier disability in multiple sclerosis. Based on these associations, patients with multiple sclerosis are frequently supplemented with the vitamin D precursor cholecalciferol, although it is unclear whether this regimen is of therapeutic benefit. To model consequences of this common practice, mice were fed for more than 3 months with a low, medium or high dose of cholecalciferol, representative of vitamin D deficiency, modest and disproportionally high supplementation, respectively, in patients with multiple sclerosis. Compared to vitamin D-deprived mice, its moderate supplementation reduced the severity of subsequent experimental autoimmune encephalomyelitis, which was associated with an expansion of regulatory T cells. Direct exposure of murine or human T cells to vitamin D metabolites inhibited their activation. In contrast, mice with 25-(OH) vitamin D levels above 200 nmol/l developed fulminant experimental autoimmune encephalomyelitis with massive CNS infiltration of activated myeloid cells, Th1 and Th17 cells. When dissecting this unexpected outcome, we observed that high, but not medium dose vitamin D had caused mild hypercalcaemia, which rendered T cells more prone to pro-inflammatory activation. Exposing murine or human T cells to equivalent calcium concentrations in vitro enhanced its influx, triggering activation, upregulation of pro-inflammatory gene products and enhanced transmigration across a blood-brain barrier model. These findings suggest that vitamin D at moderate levels may exert a direct regulatory effect, while continuous high dose vitamin D treatment could trigger multiple sclerosis disease activity by raising mean levels of T-cell excitatory calcium.
Subject(s)
Autoimmunity/drug effects , Calcium Signaling/drug effects , T-Lymphocyte Subsets/drug effects , Vitamin D/toxicity , Animals , Blood-Brain Barrier , Calcifediol/blood , Calcium/blood , Calcium/therapeutic use , Calcium/toxicity , Chlorides/blood , Cholecalciferol/adverse effects , Cholecalciferol/therapeutic use , Dose-Response Relationship, Drug , Encephalomyelitis, Autoimmune, Experimental/immunology , Female , Humans , Hypercalcemia/chemically induced , Hypercalcemia/immunology , Lymphocyte Activation/drug effects , Mice , Mice, Inbred C57BL , Mice, Transgenic , Multiple Sclerosis/complications , Multiple Sclerosis/immunology , Phosphates/blood , Sodium/blood , T-Lymphocyte Subsets/immunology , T-Lymphocyte Subsets/metabolism , Th1 Cells/drug effects , Th1 Cells/immunology , Th17 Cells/drug effects , Th17 Cells/immunology , Vitamin D/blood , Vitamin D Deficiency/complications , Vitamin D Deficiency/drug therapy , Vitamin D Deficiency/immunologyABSTRACT
BACKGROUND: The multiple biological effects of vitamin D and its novel activities on inflammation and redox homeostasis have raised high expectations on its use as a therapeutic agent for multiple fibrogenic conditions. We have assessed the therapeutic effects of 1α,25-Dihydroxyvitamin D3, the biologically active form of vitamin D, in the context of lung fibrosis. METHODS: We have used representative cellular models for alveolar type II cells and human myofibroblasts. The extension of DNA damage and cellular senescence have been assessed by immunofluorescence, western-blot and senescence-associated ß-galactosidase activity. We have also set up a murine model for lung fibrosis by intraperitoneal injections of bleomycin. RESULTS: Vitamin D induces cellular senescence in bleomycin-treated alveolar epithelial type II cells and aggravates the lung pathology induced by bleomycin. These effects are probably due to an alteration of the cellular DNA double-strand breaks repair in bleomycin-treated cells. CONCLUSIONS: The detrimental effects of vitamin D in the presence of a DNA damaging agent might preclude its use as an antifibrogenic agent for pulmonary fibrosis characterized by DNA damage occurrence and cellular senescence.
Subject(s)
Cellular Senescence/drug effects , DNA Damage , Epithelial Cells/drug effects , Pulmonary Fibrosis/pathology , Vitamin D/analogs & derivatives , A549 Cells , Animals , Bleomycin , Epithelial Cells/metabolism , Female , Humans , Lung/drug effects , Lung/pathology , Mice, Inbred C57BL , Myofibroblasts/drug effects , Myofibroblasts/metabolism , Pulmonary Fibrosis/chemically induced , Vitamin D/toxicityABSTRACT
Vitamin D deficiency is an increasing problem affecting all ages. Patients should be assessed for risk factors as part of preventive health maintenance. Vitamin D toxicity is a rare occurrence caused by oversupplementation and errors in food fortification. The connection between vitamin D deficiency and osteoporosis, is well established. However, a cause and effect relationship has yet to be established between vitamin D deficiency and many chronic illnesses. An evidence-based approach is treating patients for an underlying vitamin D deficiency in hopes of improving many chronic illnesses.
Subject(s)
Vitamin D Deficiency/complications , Vitamin D/toxicity , Vitamins/toxicity , Accidental Falls , Alzheimer Disease/etiology , Asthma/etiology , Cardiovascular Diseases/etiology , Dementia/etiology , Diabetes Mellitus/blood , Diet , Humans , Irritable Bowel Syndrome/complications , Neoplasms/mortality , Osteomalacia/etiology , Physical Functional Performance , Recommended Dietary Allowances , Respiratory Tract Infections/etiology , Rickets/etiology , Risk Factors , Vitamin D/physiology , Vitamin D/therapeutic use , Vitamin D Deficiency/etiology , Vitamins/therapeutic useABSTRACT
BACKGROUND: Interest in vitamin D has increased during the past 2 decades, with a corresponding increase in laboratory testing of 25-hydroxyvitamin D [25(OH)D]. The vast majority of specimens tested display normal or deficient levels of 25(OH)D; concentrations rarely fall in the potentially toxic range. METHODS: We performed a retrospective investigation of elevated 25(OH)D levels during a 16-year period at the University of Iowa Hospitals and Clinics (UIHC), a 734-bed tertiary-/quaternary-care academic medical center in the midwestern United States. Detailed medical-record review was performed for patients with serum/plasma 25(OH)D concentrations higher than 120 ng per mL. RESULTS: A total of 127,932 serum/plasma 25(OH)D measurements were performed on 73,779 unique patients. Of these patients, 780 (1.05%) had results that exceeded 80 ng per mL and 89 patients (0.12%) had results that exceeded 120 ng per mL. Only 4 patients showed symptoms of vitamin D toxicity. Three of these cases involved inadvertent misdosing of liquid formulations. CONCLUSIONS: Symptomatic vitamin D toxicity is uncommon, and elevated levels of 25(OH)D do not strongly correlate with clinical symptoms or total serum/plasma calcium levels. Our study highlights the potential risks of the liquid formulation of vitamin D.
Subject(s)
Vitamin D/analogs & derivatives , Adolescent , Adult , Aged , Aged, 80 and over , Calcium/blood , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Iowa , Linear Models , Male , Middle Aged , Retrospective Studies , Vitamin D/blood , Vitamin D/therapeutic use , Vitamin D/toxicity , Young AdultABSTRACT
OBJETIVO: Describir la relevancia del déficit de vitamina D durante la gestación, así como sus consecuencias y sus factores de riesgo, y evaluar la necesidad de administración de suplementos para su tratamiento. METODOLOGÍA: Revisión bibliográfica de las bases de datos Turning Research Into Practice, Evidence-Based Nursing, Joanna Briggs Institute, Biblioteca Cochrane Plus, guías de la National Institute of Health and Care Excellence, PubMed, Índice Médico Español (IME), Cumulative Index to Nursing and Allied Health Literature (CINAHL), en inglés y español, y de la disponibilidad en la biblioteca desde la cual se hacía la consulta. La última búsqueda se efectuó en diciembre de 2017. RESULTADOS: Se obtuvo un total de 127 referencias bibliográficas, de las que 30 cumplían los criterios de selección. Se seleccionaron 26 artículos: 15 artículos originales, 5 revisiones bibliográficas y 6 guías de práctica clínica y protocolos de actuación. CONCLUSIONES: La vitamina D es fundamental en todas las etapas de la vida de la mujer. El déficit de vitamina D en las gestantes es un hecho constatado en los estudios internacionales actuales. Se describe la necesidad de optimizar los niveles de vitamina D durante la gestación, dado que su déficit está relacionado con complicaciones importantes que pueden afectar tanto a la madre como al recién nacido, e incluso a la vida futura de ambos. No obstante, la necesidad, la seguridad y la eficacia de los suplementos de vitamina D administrados de manera sistemática y preventiva durante el embarazo es un tema no exento de controversia entre los profesionales, dado su potencial efecto tóxico. No se dispone de estudios que demuestren el beneficio de los suplementos de vitamina D a corto y largo plazo. Cabe destacar que no parecen tener un efecto teratogénico ni ser potencialmente nocivos para la gestante
AIM: To describe the relevance of vitamin D deficiency during pregnancy, as well as its consequences and risk factors, and to evaluate the need for supplementation for its treatment. METHODOLOGY: Bibliographic review of Turning Research Into Practice databases, Evidence-Based Nursing, Joanna Briggs Institute, Cochrane Plus Library, guides of the National Institute of Health and Care Excellence, PubMed, Spanish Medical Index (IME), Cumulative Index to Nursing and Allied Health Literature (CINAHL) in English and Spanish and availability in the library from which the consultation was made. Last search December of 2017. RESULTS: A total of 127 bibliographical references were obtained, of which 30 met the selection criteria. After reading the abstracts and checking if there was documentary duplication from the different databases, a total of 26 articles were selected. Of these, 15 are original articles, 5 are a bibliographic review and 6 are action guides. CONCLUSIONS: Vitamin D is essential in all stages of a woman's life. The deficit of Vitamin D in pregnant women is a fact described in the current studies worldwide. The need to optimize vitamin D levels during pregnancy is described, because its deficit is related to important complications that can affect the mother and the newborn and even the future life of both. However, the need, safety and efficacy of vitamin D supplements administered routinely and preventively during pregnancy is a controversial issue among professionals, given its potential toxic effect. There are no studies that demonstrate its short and long-term benefit. It should be noted that it does not seem to have a teratogenic effect nor does it seem to be potentially harmful for the pregnant woman
Subject(s)
Humans , Female , Pregnancy , Vitamin D/toxicity , Vitamin D Deficiency/complications , Pregnancy , Dietary SupplementsABSTRACT
Vitamin D deficiency and insufficiency is a global health issue that afflicts more than one billion children and adults worldwide. The consequences of vitamin D deficiency cannot be under estimated. There has been an association of vitamin D deficiency with a myriad of acute and chronic illnesses including preeclampsia, childhood dental caries, periodontitis, autoimmune disorders, infectious diseases, cardiovascular disease, deadly cancers, type 2 diabetes and neurological disorders. This review is to put into perspective the controversy surrounding the definition for vitamin D deficiency and insufficiency as well as providing guidance for how to treat and prevent vitamin D deficiency.
Subject(s)
Vitamin D Deficiency/diagnosis , Vitamin D Deficiency/epidemiology , Vitamin D Deficiency/therapy , Adult , Child , Humans , Nutrition Assessment , Nutrition Policy , Pandemics , Risk Factors , Vitamin D/administration & dosage , Vitamin D/analysis , Vitamin D/blood , Vitamin D/toxicity , Vitamin D Deficiency/prevention & controlABSTRACT
KEY POINTS: Hypercalcaemia can occur under various pathological conditions, such as primary hyperparathyroidism, malignancy or granulomatosis, and it induces natriuresis and polyuria in various species via an unknown mechanism. A previous study demonstrated that hypercalcaemia induced by vitamin D in rats increased endothelin (ET)-1 expression in the distal nephron, which suggests the involvement of the ET system in hypercalcaemia-induced effects. In the present study, we demonstrate that, during vitamin D-induced hypercalcaemia, the activation of ET system by increased ET-1 is responsible for natriuresis but not for polyuria. Vitamin D-treated hypercalcaemic mice showed a blunted response to amiloride, suggesting that epithelial sodium channel function is inhibited. We have identified an original pathway that specifically mediates the effects of vitamin D-induced hypercalcaemia on sodium handling in the distal nephron without affecting water handling. ABSTRACT: Acute hypercalcaemia increases urinary sodium and water excretion; however, the underlying molecular mechanism remains unclear. Because vitamin D-induced hypercalcaemia increases the renal expression of endothelin (ET)-1, we hypothesized that ET-1 mediates the effects of hypercalcaemia on renal sodium and water handling. Hypercalcaemia was induced in 8-week-old, parathyroid hormone-supplemented, male mice by oral administration of dihydrotachysterol (DHT) for 3 days. DHT-treated mice became hypercalcaemic and displayed increased urinary water and sodium excretion compared to controls. mRNA levels of ET-1 and the transcription factors CCAAT-enhancer binding protein ß and δ were specifically increased in the distal convoluted tubule and downstream segments in DHT-treated mice. To examine the role of the ET system in hypercalcaemia-induced natriuresis and polyuria, mice were treated with the ET-1 receptor antagonist macitentan, with or without DHT. Mice treated with both macitentan and DHT displayed hypercalcaemia and polyuria similar to that in mice treated with DHT alone; however, no increase in urinary sodium excretion was observed. To identify the affected sodium transport mechanism, we assessed the response to various diuretics in control and DHT-treated hypercalcaemic mice. Amiloride, an inhibitor of the epithelial sodium channel (ENaC), increased sodium excretion to a lesser extent in DHT-treated mice compared to control mice. Mice treated with either macitentan+DHT or macitentan alone had a similar response to amiloride. In summary, vitamin D-induced hypercalcaemia increases the renal production of ET-1 and decreases ENaC activity, which is probably responsible for the rise in urinary sodium excretion but not for polyuria.
Subject(s)
Endothelin-1/physiology , Hypercalcemia/metabolism , Natriuresis/physiology , Polyuria/metabolism , Vitamin D/toxicity , Acute Disease , Animals , Cell Line, Transformed , Hypercalcemia/chemically induced , Hypercalcemia/urine , Kidney Tubules/drug effects , Kidney Tubules/metabolism , Male , Mice , Mice, Inbred C57BL , Natriuresis/drug effects , Polyuria/urineABSTRACT
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.
Subject(s)
Hypercalcemia/chemically induced , Prescription Drug Overuse/statistics & numerical data , Self Administration/statistics & numerical data , Vitamin D Deficiency/diet therapy , Vitamin D/analogs & derivatives , Adult , Chromatography, Liquid , Dried Blood Spot Testing , Drug Administration Schedule , Female , Humans , Hypercalcemia/blood , Hypercalcemia/diagnosis , Male , Middle Aged , Tandem Mass Spectrometry , Time Factors , Vitamin D/blood , Vitamin D/toxicity , Vitamin D Deficiency/blood , Vitamin D Deficiency/physiopathologyABSTRACT
Vitamin D is a pro-hormone that plays an important role in body calcium regulation. Vitamin D toxicity occurs rarely due to its wide therapeutic index. A 38-year-old Iranian man was admitted to our hospital with a diagnosis of vitamin D toxicity. Laboratory test revealed hypercalcemia and elevated 25-hydroxyvitamin D (25(OH)D) level. Despite the cessation of vitamin D intake and diuretic treatment, he presented four months later with high 25(OH)D level and similar clinical features. Due to the potential release of vitamin D from adipose tissue, serial monitoring of 25(OH)D level is recommended.
Subject(s)
Adipose Tissue/chemistry , Calcium/blood , Hypercalcemia/diagnosis , Vitamin D/analogs & derivatives , Vitamin D/toxicity , Adult , Electrocardiography , Humans , Iran , Male , Vitamin D/bloodABSTRACT
To document the biochemical and pathologic features of vitamin D intoxication in lynx and to characterize mineral metabolism in healthy lynx, blood samples were obtained from 40 captive lynx that had been receiving excessive (approximately 30 times the recommended dose) vitamin D3 in the diet, and from 29 healthy free ranging lynx. Tissue samples (kidney, stomach, lung, heart and aorta) were collected from 13 captive lynx that died as a result of renal disease and from 3 controls. Vitamin D intoxication resulted in renal failure in most lynx (n = 28), and widespread extraskeletal calcification was most severe in the kidneys and less prominent in cardiovascular tissues. Blood minerals and calciotropic hormones in healthy lynx were similar to values reported in domestic cats except for calcitriol which was higher in healthy lynx. Changes in mineral metabolism after vitamin D intoxication included hypercalcemia (12.0 ± 0.3 mg/dL), hyperphosphatemia (6.3 ± 0.4 mg/dL), increased plasma calcidiol (381.5 ± 28.2 ng/mL) and decreased plasma parathyroid hormone (1.2 ± 0.7 pg/mL). Hypercalcemia and, particularly, hyperphosphatemia were of lower magnitude that what has been previously reported in the course of vitamin D intoxication in other species. However, extraskeletal calcifications were severe. The data suggest that lynx are sensitive to excessive vitamin D and extreme care should be taken when supplementing this vitamin in captive lynx diets.
