Vitamin D Toxicity and Clinical Consequences of Hypervitaminosis
DOI:
https://doi.org/10.53933/sspmpm.v5i2.186Keywords:
vitamin D, toxicity, hypervitaminosis, overdose, hypercalcemia, regulation of bone metabolism, side effectsAbstract
Vitamin D is an essential fat-soluble vitamin that enters the human body with certain animal products, fortified foods, dietary supplements, and is also synthesized endogenously under the influence of solar radiation. It plays a critical role in regulating calcium-phosphorus metabolism and maintaining bone health, preventing the development of rickets and osteopenia. In recent years, there has been a growing body of evidence regarding its involvement in numerous metabolic processes and potential link to the risk of autoimmune diseases, cancer, cardiovascular disease, depression, dementia and infectious diseases.
However, despite the widespread use and availability of vitamin D, including in the form of over-the-counter supplements, there is a risk of developing hypervitaminosis D, which, although rare, can have serious clinical consequences. Vitamin D toxicity is usually caused by excessive intake of high doses of the vitamin (intentional or accidental), prescription errors, or lack of proper monitoring of vitamin D levels during treatment of certain diseases (e.g., osteoporosis, renal osteodystrophy, malabsorption).
Clinical manifestations of hypervitaminosis D are caused by hypercalcemia and can range from nonspecific symptoms (weakness, fatigue, anorexia, bone pain) to more serious neurological (confusion, apathy, ataxia), gastrointestinal (nausea, vomiting, constipation, pancreatitis), renal (polyuria, polydipsia, nephrolithiasis) and cardiac (arrhythmias) disorders. Treatment is mainly supportive and aimed at lowering calcium levels by discontinuing vitamin D and calcium intake, rehydration, and in severe cases, calcitonin, bisphosphonates, sometimes glucocorticoids, or hemodialysis.
References
Moulas A., Vaiou M. Fortification of foods with vitamin D and potential health outcomes. J Biotechnology. 2018. Vol. 285. Iss. 91. P. 91–101. URL: https://pubmed.ncbi.nlm.nih.gov/29555229/ DOI: https://doi.org/10.1016/j.jbiotec.2018.08.010
Haines S.T., Park S.K. Vitamin D supplementation: what is known, what is done, and what is needed. Pharmacotherapy. 2012. Vol. 32. No. 4. P. 354–382. URL: https://pubmed.ncbi.nlm.nih.gov/22460847/ DOI: https://doi.org/10.1002/phar.1037
Osyntseva A. The Potential of Vitamin D in Tuberculosis Pharmacotherapy: Retrospective, Marketing Review, and Application Prospects. SSP Modern Pharmacy and Medicine. 2025. Vol. 5. No. 1. P. 1–15. URL: https://doi.org/10.53933/sspmpm.v5i1.172 DOI: https://doi.org/10.53933/sspmpm.v5i1.172
Shapovalova V. Innovative approaches to medical and pharmaceutical care, pharmacotherapy, and availability of pharmaceutical supplies for Tuberculosis patients in wartime. SSP Modern Pharmacy and Medicine. 2025. Vol.5. No.1. P.1-17. URL: https://doi.org/10.53933/sspmpm.v5i1.170 DOI: https://doi.org/10.53933/sspmpm.v5i1.170
Shapovalov (Jr.) V., Shapovalova V., Gudzenko A. et al. Organizational and legal analysis of the pharmaceutical provision for the most common diseases of society. International Journal of Pharmaceutical Sciences Review and Research. 2018. Vol.51. Nо.1. P. 118-124. URL: http://globalresearchonline.net/journalcontents/v51-1/18.pdf.
Shapovalova V. The ICD-11 for the twenty-first century: the first view from the organizational, legal, clinical and pharmacological aspects. SSP Modern Pharmacy and Medicine. 2022. Vol.2. Nо.1. Р.1–13. URL: https://doi.org/10.53933/sspmpm.v2i1.37 DOI: https://doi.org/10.53933/sspmpm.v2i1.37
Shapovalova V. Forensic and pharmaceutical risks in the organization of pharmacotherapy of covid, post-covid and long-covid disorders. COVID-19 and vaccination practice standards. SSP Modern Pharmacy and Medicine. 2022. Vol. 2. No. 4. P. 1–24. URL: https://doi.org/10.53933/sspmpm.v2i4.69. DOI: https://doi.org/10.53933/sspmpm.v2i4.69
Shapovalova V. Administration, marketing, pharmacotherapy of medicines in Neuro-Oncology. SSP Modern Pharmacy and Medicine. 2024. Vol.4. No.4. P.1-12. URL: https://doi.org/10.53933/sspmpm.v4i4.161 DOI: https://doi.org/10.53933/sspmpm.v4i4.161
Shapovalova V. Post-Traumatic Stress Disorder: administration, clinical and pharmacological, organizational and legal, pharmaceutical management, recent case studies. SSP Modern Pharmacy and Medicine. 2024. Vol.4. No.1. P.1-8. URL: https://doi.org/10.53933/sspmpm.v4i1.123 DOI: https://doi.org/10.53933/sspmpm.v4i1.123
Shapovalova V. Monkeypox virus – new challenges of modernity: experimental organizational and legal, clinical and pharmacological studies. SSP Modern Pharmacy and Medicine. 2022. Vol.2. N.3. P.1-15. URL: https://doi.org/10.53933/sspmpm.v2i3.54. DOI: https://doi.org/10.53933/sspmpm.v2i3.54
Shapovalova V. Pharmacotherapy of Depressive disorders in conditions of coronavirus disease: pharmacoeconomic experimental study. SSP Modern Pharmacy and Medicine. 2023. Vol.3. No.3. P.1-11. URL: https://doi.org/10.53933/sspmpm.v3i3.101 DOI: https://doi.org/10.53933/sspmpm.v3i3.101
Shapovalov V. Multidisciplinary Study of Medical Errors in the System of Legal Relations Between "Doctor-Patient-Pharmacist-Advocate" During the Circulation of Drugs. SSP Modern Pharmacy and Medicine. 2023. Vol. 3. No. 2. Р. 1-10. DOI: https://doi.org/10.53933/sspmpm.v3i2.88 DOI: https://doi.org/10.53933/sspmpm.v3i2.88
Ozkan B., Hatun S., Bereket A. Vitamin D intoxication. Turk J Pediatr. 2012. Vol. 54. No. 2. P. 93–98. URL: https://pubmed.ncbi.nlm.nih.gov/22792674/
Marcinowska-Suchowierska E., Kupisz-Urbańska M., Łukaszkiewicz J., Płudowski P., Jones G. Vitamin D Toxicity – A Clinical Perspective. Front Endocrinol (Lausanne). 2018. Vol. 9. P. 550. URL: https://pubmed.ncbi.nlm.nih.gov/30377554/ DOI: https://doi.org/10.3389/fendo.2018.00550
Kaur P., Mishra S.K., Mithal A. Vitamin D toxicity resulting from overcorrection of vitamin D deficiency. Clin Endocrinol (Oxf). 2015. Vol. 83. No. 3. P. 327–331. URL: https://pubmed.ncbi.nlm.nih.gov/25515793/ DOI: https://doi.org/10.1111/cen.12836
Taylor P.N., Davis J.S. A review of the increasing risk of vitamin D toxicity due to inappropriate practices. Br J Clin Pharmacol. 2018. Vol. 84. No. 6. P. 1121–1127. URL: https://pubmed.ncbi.nlm.nih.gov/29436125/ DOI: https://doi.org/10.1111/bcp.13573
Mouton Sclaunich H., Marchand C., Rekik A. et al. A case of iatrogenic vitamin D toxicity revealed by drug reconciliation. Therapy. 2022. Vol. 77. No. 3. P. 388–390. URL: https://pubmed.ncbi.nlm.nih.gov/35430991/ DOI: https://doi.org/10.1016/j.therap.2021.07.005
Golik M.F. Vitamin D is not as toxic as once thought: a historical and contemporary perspective. Mayo Clin Proc. 2015. Vol. 90. No. 5. P. 561–564. URL: https://pubmed.ncbi.nlm.nih.gov/25937113/ DOI: https://doi.org/10.1016/j.mayocp.2015.03.015
Hoorn E.J., Zietse R. Disorders of calcium and magnesium balance: a physiological approach. Pediatr Nephrol. 2013. Vol. 28. No. 8. P. 1195–1206. URL: https://pubmed.ncbi.nlm.nih.gov/23381388/ DOI: https://doi.org/10.1007/s00467-012-2350-2
Studdert V.P. Toxicity of rodenticides containing cholecalciferol to dogs and cats. Aust Vet J. 1990. Vol. 67. No. 6. P. N218. URL: https://pubmed.ncbi.nlm.nih.gov/2372783/
De Clementi S., Sobchak B.R. Common rodenticide toxicoses in small animals. Vet Clin North Am Small Anim Pract. 2018. Vol. 48. No. 6. P. 1027–1038. URL: https://pubmed.ncbi.nlm.nih.gov/30174069/ DOI: https://doi.org/10.1016/j.cvsm.2018.06.006
Holick M.F., Binkley N.K., Bischoff-Ferrari H.A. et al. Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: Endocrine Society clinical practice guidelines. J Clin Endocrinol Metab. 2011. Vol. 96. No. 7. P. 1911–1930. URL: https://pubmed.ncbi.nlm.nih.gov/21646365/ DOI: https://doi.org/10.1210/jc.2011-0385
Jones G. Pharmacokinetics of vitamin D toxicity. Am J Clin Nutr. 2008. Vol. 88. No. 2. P. 582S–586S. URL: https://pubmed.ncbi.nlm.nih.gov/18689388/ DOI: https://doi.org/10.1093/ajcn/88.2.582S
Lee K.W., Cohen K.L., Walters J.B. et al. Iatrogenic vitamin D intoxication: a case report and review of vitamin D physiology. Conn Med. 1999. Vol. 63. No. 7. P. 399–403. URL: https://pubmed.ncbi.nlm.nih.gov/10489504/
Silva C., Fung A.V.S., Masson W. et al. Vitamin D toxicity from an unusual and unexpected source: report of 2 cases. Horm Res Paediatr. 2023. Vol. 96. No. 3. P. 332–340. URL: https://pubmed.ncbi.nlm.nih.gov/36623384/ DOI: https://doi.org/10.1159/000526755
Schulster M.L., Goldfarb D.S. Vitamin D and kidney stones. Urology. 2020. Vol. 139. P. 1–7. URL: https://pubmed.ncbi.nlm.nih.gov/31935480/ DOI: https://doi.org/10.1016/j.urology.2020.01.030
Goldfarb D.S. Does vitamin D supplementation cause kidney stones? J Urol. 2017. Vol. 197. No. 2. P. 280–281. URL: https://pubmed.ncbi.nlm.nih.gov/27586875/ DOI: https://doi.org/10.1016/j.juro.2016.11.072
Nordt S.P., Williams S.R., Clark R.F. Pharmacological failure leading to hypercalcemia due to vitamin D intoxication. J Emerg Med. 2002. Vol. 22. No. 3. P. 302–303. URL: https://pubmed.ncbi.nlm.nih.gov/11967102/ DOI: https://doi.org/10.1016/S0736-4679(01)00495-4
Chatterjee M., Speiser P.V. Treatment with pamidronate hypercalcemia caused by vitamin D toxicity. J Pediatr Endocrinol Metab. 2007. Vol. 20. No. 11. P. 1241–1248. URL: https://pubmed.ncbi.nlm.nih.gov/18260383/ DOI: https://doi.org/10.1515/JPEM.2007.20.11.1241
Lee D.C., Lee G.Y. Use of pamidronate in hypercalcemia due to acute vitamin D intoxication. J Toxicol Clin Toxicol. 1998. Vol. 36. No. 7. P. 719–721. URL: https://pubmed.ncbi.nlm.nih.gov/9863164/ DOI: https://doi.org/10.3109/15563659809162621
Fatemi S., Spivak F.R., Rud R.K. Effect of salmon calcitonin and etidronate on hypercalcemia of malignancy. Calcif Tissue Int. 1992. Vol. 50. No. 2. P. 107–109. URL: https://pubmed.ncbi.nlm.nih.gov/1739766/ DOI: https://doi.org/10.1007/BF00298784
Kimberg D.V., Berg R.D., Gershon E. et al. Effect of cortisone treatment on active calcium transport in the small intestine. J Clin Invest. 1971. Vol. 50. No. 6. P. 1309–1321. URL: https://pubmed.ncbi.nlm.nih.gov/5581471/ DOI: https://doi.org/10.1172/JCI106610
Wani M., Wani I., Banday K. et al. The other side of vitamin D therapy: a case series of acute kidney injury due to vitamin D intoxication associated with abuse. Clin Nephrol. 2016. Vol. 86. No. 5. P. 236–241. URL: https://pubmed.ncbi.nlm.nih.gov/27654173/ DOI: https://doi.org/10.5414/CN108904
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Yuriy Fedorov, Alona Kovpak

This work is licensed under a Creative Commons Attribution 4.0 International License.