As I mentionned before, this patient was transfered to our hospital from an
other region. So we didn't had all the information. We finally found that he
was receiving since august 6 calcium Carbonate (500 mg) and 50,000 units/day
of vitamin D2.
Ihssan
William D Fraser wrote:
> Care is required interpreting 25OHD concentrations. If this patient was
> taking a supplement that contains 25OHD2 rather than 25OHD3 the
> immunoassays that are currently available to measure total 25OHD recognise
> very little of the circulating form of 25OHD2. They also have different
> reactivities and responses to 25OHD3. This is an important point when
> reviewing the work published by Veith as he used an assay that does not
> recognise vitamin D2 and has the strongest positive bias for D3 in DEQAS
> and came out with the conclusion that vitamin D2 as a supplement was
> relatively "inactive". The problems of assays are starting to be addressed
> in some detail(see Glendenning et al Annals Clin Biochem 2003) and a
> suggestion has been made that at present we should use assay specific
> ranges when determining deficiency and toxicity.
>
> Bill Fraser
>
> --On 09 December 2003 10:55 +0000 Mohammad Al-Jubouri
> <[log in to unmask]> wrote:
>
> > I agree 25-OH vit D not terribly high to cause
> > hypercalcaemia of 4.6 mmol/L on its own. She is
> > obviously taking some vitamin D supplement of some
> > sort, as serum 25-OH vit D level is higher than can be
> > achieved by even the most enthusiastic sun bathers.
> > Calcium and vitamin A supplements should also be
> > sought meticulously in the history. Has she responded
> > to high dose steroid or any other therapy?
> >
> > regards
> >
> > Mohammad
> >
> >
> > --- ablumsohn <[log in to unmask]> wrote: > Not
> > 100% convinced that this would be your sole
> >> diagnosis. Enthusiastic lifeguards can get
> >> plasma 25D in this sort of range, and they don't
> >> generally get severe hypercalcaemia. There is an
> >> argument proposed by some (eg Veith) that almost
> >> everyone with 25D below the upper limit of the
> >> summer
> >> reference range you give (85nmol/L) is Vitamin D
> >> deficient.
> >>
> >> It is pretty hard to make oneself severely vitamin D
> >> toxic and markedly hypercalcaemic using easily
> >> available sources of Vitamin D.
> >>
> >> Case reports of vitamin D intoxication with severe
> >> hypercalcaemia generally have very high doses (eg
> >> 50,000 units of Vitamin D per day for long periods
> >> of time)
> >> See for example N Eng J Med 345. 66 (2001), or the
> >> Lancet case collection May 31st 1980 (mostly
> >> iatrogenic).
> >>
> >> Possible, but.... what vitamin D did he take and
> >> where
> >> did he get it? Was it in the form of a calcium/D
> >> supplement? - in which case he probably has calcium
> >> rather than Vitamin D poisoning.
> >>
> >> Aubrey
> >>
> >>
> >> DIB> I received the results of Vit D. The
> >> DIB> patient was hospitalized the 25th
> >> DIB> of November. The results of the specimen
> >> DIB> taken the 1st of December
> >> DIB> were:
> >> DIB> 1,25 Vit D 118.2 pM (RV 41-145)
> >> DIB> 25 Vit D 212.8 nM (RV summer 35 - 85;
> >> winter 25 - 60)
> >>
> >> DIB> So most probably it was a case of vit D.
> >> intoxication
> >>
> >> DIB> Thanks for your comments and suggestions in
> >> this case.
> >>
> >> DIB> Ihssan
> >>
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> > =====
> > Dr. M A Al-Jubouri
> > Consultant Chemical Pathologist
> >
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> Professor W D Fraser
> Department of Clinical Chemistry
> The University of Liverpool
> 4th Floor, Duncan Building
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> Liverpool
> L69 3GA
>
> Tel: 0151 706 4247/4257
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