Vitamin D toxicity is extremely rare, none if less than 180 ng

Vitamin D Toxicity: A 16-Year Retrospective Study at an Academic Medical Center.

Lab Med. 2018 Mar 21;49(2):123-129. doi: 10.1093/labmed/lmx077.

Lee JP1, Tansey M2, Jetton JG3, Krasowski MD1.

1 Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA.

2 Divisions of Pediatric Endocrinology, University of Iowa Stead Family Children's Hospital, Iowa City, IA.

3 Divisions of Pediatric Nephrology, Dialysis, and Transplantation, University of Iowa Stead Family Children's Hospital, Iowa City, IA.

No toxicity reported for <180 ng

50,000 IU was the most popular dose size

* It appears that the single case was that of an infant consistently getting a dropperfull rather than a 1,000 IU drop ==>. Vitamin D level of 490 ng. * Since there can be 40 drops in a large dropper, the infant may have been getting 40,000 IU daily * 2000 IU of vitamin D- doctors trained that it was too much, but it is often too little * Vitamin D Toxicity is rare – only 1 unknown case in 74,000 patients – Jan 2018 * 276,000 IU of Vitamin D daily was too much – April 2021 Overview Toxicity of vitamin D has the following chart

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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.