Habib, Aysha

Iqbal, Romaina

Majid, Hafsa

English

eCommons@AKU

eCommons@AKUDepartment of Pathology and Laboratory Medicine Medical College, PakistanJuly 2014Shifting of vitamin D deficiency tohypervitaminosis and toxicityAysha HabibAga Khan University, aysha.habib@aku.eduHafsa MajidRomaina IqbalAga Khan University, romaina.iqbal@aku.eduFollow this and additional works at: http://ecommons.aku.edu/pakistan_fhs_mc_pathol_microbiolPart of the Microbiology Commons, and the Pathology CommonsRecommended CitationHabib, A., Majid, H., Iqbal, R. (2014). Shifting of vitamin D deficiency to hypervitaminosis and toxicity. JCPSP: Journal of the Collegeof Physicians and Surgeons Pakistan, 24(7), 536-536.Available at: http://ecommons.aku.edu/pakistan_fhs_mc_pathol_microbiol/470536 Journal of the College of Physicians and Surgeons Pakistan 2014, Vol. 24 (7): 536Sir,There has been an increasing awareness of roles ofVitamin D and parathyroid hormone (PTH) inmaintaining a variety of essential regulatory functions inhealth and complex role in increasing the incidence ofmany chronic diseases. Vitamin D deficiency (VDD) andsecondary hyperparathyroidism (sHPTH) in the generalpopulation are reported globally. Newer strategies andrecommendations have been put forward for dietary andsupplementation intake of Vitamin D and Calcium in thelight of pandemic of VDD.At the same time, with increased Calcium and Vitamin Dsupplementation, the incidence of renal stones hasincreased. Unprescribed and prescribed supplemen-tation and faulty preparations or errors of labelling arebeing detected and now an increasing number ofpatients are reporting with Vitamin D toxicity.1An area of great controversy in our setup is in thetreatment strategies for correcting VDD. Severalstrategies adopted have been reported in literaturerecently and practice patterns of physicians in treatingVDD are also widely variable. Very few physiciansperform complete biochemical testing to assess theoverall bone health and response to Vitamin Dreplacement.We reported that single injection of 600,000 IU ofcholecalciferol achieved Vitamin D levels above 20ng/ml in 75% of the healthy adults volunteers after 8weeks.2 There is no change in intestinal Calciumabsorption before or after Vitamin D injection andmaximum Vitamin D-dependent Calcium absorption isachieved even at lower Vitamin D levels in ourpopulation.3 The effects of these mega doses are stillunder study and practices are based on individualexperiences.We have been reporting high prevalence of VDD fromour laboratory since 2000.4,5 Recently, we noted a shiftin the data and encountered a significant number ofsubjects tested at our laboratory to be suffering fromhigh Vitamin D levels. Of more significance is the groupof subjects under one year of age reported to havelevels greater than 150 ng/ml (Table I).These finding shows that there is inadvertent use ofhigher doses of Vitamin D resulting in toxicity. Replace-ment of Vitamin D for maintaining sufficient bone healthis necessary but achieving balance between optimal andtoxic levels is equally important. For this, serum VitaminD should be tested appropriately, and doses adjustedaccordingly. Furthermore, pharmacists, physicians,nutritionists and patients should be educated about thetoxic potentials of Vitamin D as it is not a benign agent.REFERENCES1. Araki T, Holick MF, Alfonso BD, Charlap E, Romero CM, RizkD, et al. Vitamin D intoxication with severe hypercalcemia dueto manufacturing and labelling errors of two dietarysupplements made in the United States. J Clin EndocrinolMetab 2011; 96:3603-8.2. Khan AH, Rohra DK, Saghir SA, Udani SK, Wood R, Jabbar A.Response of a single 'mega intramuscular dose' of vitamin Don serum 25 OHD and parathyroid hormone levels. J CollPhysicians Surg Pak 2012; 22:207-12.3. Khan AH, Rohra DK, Saghir SA, Udani SK, Wood RJ, JabbarA. No change in calcium absorption in adult Pakistanipopulation before and after vitamin D administration usingstrontium as surrogate. Osteoporos Int 2013; 24:1057-62.4. Mansoor S, Habib A, Ghani F, Fatmi Z, Badruddin S, SiddiquiI, et al. Prevalence and significance of vitamin D deficiency andinsufficiency among apparently healthy adults. Clin Biochem2010; 43:1431-5.5. Khan AH, Iqbal R, Naureen G, Dar FJ, Ahmed FN. Prevalenceof vitamin D deficiency and its correlates: results of acommunity-based study conducted in Karachi, Pakistan. ArchOsteoporos 7:275-82.LETTER TO THE EDITORShifting of Vitamin D Deficiencyto Hypervitaminosis and ToxicityTable I: Frequency of children with high and toxic Vitamin D levelsreported from clinical laboratories of the Aga Khan UniversityHospital, Karachi.25(OH)D levels Frequency (%) Mean ± SDDeficiency (< 20.0 ng/ml) 886 (39.4%) 11.2 ± 5.4Insufficient (> 20.0 - 30.0 ng/ml) 553 (24.6%) 24.6 ± 2.7Sufficient (30 - 80 ng/ml) 590 (26.2%) 44.8 ± 13.5High (80 - 150 ng/ml) 148 (6.6%) 110 ± 21.6Toxicity (> 150 ng/ml) 72 (3.2%) 152.9 ± 11.6Aysha Habib Khan1, Hafsa Majid1 and Romaina Iqbal2Department of Pathology and Microbiology1 / CommunityHealth Sciences,2 The Aga Khan University Hospital, Karachi.Correspondence: Dr. Aysha Habib Khan, 116 A/II, 16th Street,Off Mohajid, Phase VI, DHA, Karachi.E-mail: aysha.habib@aku.eduReceived: December 07, 2013;   Accepted: April 05, 2014.

Shifting of vitamin D deficiency to hypervitaminosis and toxicity

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Shifting of vitamin D deficiency to hypervitaminosis and toxicity

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