. "Appendix G: Cases Studies of Vitamin D Toxicity." Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press, 2011.
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DRI Dietary Reference Intakes Calcium Vitamin D
Serum Calcium
Serum 25(OH)D
Symptoms/Health Effects
Edema and albuminuria
Response from editor: A toxic dose of more than 200,000 units would only be achieved with ingestion of 2.65 L cod liver oil/d
18–19 mg/dL
All presented with anorexia, weight loss, weakness; 2 infants recovered within 6–9 mo following removal of vitamin D; 2 infants died: autopsy showed fibrotic changes in vascular tissue, calcification of other tissues was noted, particularly lung
Both cases presented with anorexia, diarrhea, and vomiting
10.5 mg/dL
129 ng/ml
10.5 mg/dL
126 ng/ml
19.5 mg/dL
Calcium phosphate crystals in urine; bilateral medullary nephrocalcinosis; vomiting and lethargy; both pts recovered without incident
17.6 mg/dL
Extreme thirst, hypercalcemia, symptoms of diabetes insipidus
17.2 mg/dL
635 ng/ml
Leg pain, cessation of growth resulting from bone resorption; serum calcium, accompanied by nausea and vomiting. Tx with Ca-free dialysate failed to reduce serum Ca; prednisolone for 7 d; calcitonin tx stabilized serum Ca
17 mg/dL
Nausea and non-tender lumps over both tibias; X-rays showed alternating patterns of increased and decreased bone density. Loss of bone density and tissue calcification continued despite removal of vitamin D and the pt died
14.4 mg/dL
470 ng/ml
Constipation and colic; persistent hypertension; no renal, cardiac, neurological symptoms noted. Acute toxicity treated with furosemide, calcitonin, and hydrocortisol
