Friday, 20 January 2012

High calcium levels on vitamin D supplements

Marcus et al. Severe hypercalcemia following vitamin d supplementation in a patient with multiple sclerosis: a note of caution. Arch Neurol. 2012 Jan;69(1):129-32.

OBJECTIVE: To describe a patient with multiple sclerosis (MS) who developed severe hypercalcemia, attributed to the additive effect of 5500 IU of cholecalciferol and 2020 mg of calcium daily.

RESULTS: The patient's corrected serum calcium level was 15.2 mg/dL (reference range, 8.7-10.1 mg/dL; to convert to millimoles per liter, multiply by 0.25), and her 25-hydroxyvitamin D level was 103 ng/mL (to convert to nanomoles per liter, multiply by 2.496). The results of extensive laboratory tests to rule out hyperparathyroidism, malignant neoplasms, and other causes of hypercalcemia were unrevealing.

CONCLUSIONS: It is common practice to prescribe high-dose vD to MS'ers for its possible role in immunomodulation and relapse-rate reduction. Nevertheless, vD may increase serum calcium, and there seems to be an additive effect when patients simultaneously use calcium supplements. This case underscores the need for physicians to be attentive to the possibility of hypercalcemia in MS'ers treated with both high-dose vD and calcium.

"The take home message is that if you are taking vD supplements you should not be taking Calcium supplements as well."

"Please note this complication of vD supplementation is very rare."

"Please note vD and calcium are given in combination to treat osteoporosis or diseases with bone thinning."

You need to be aware of the symptoms of high calcium levels:
  1. Stones (renal or biliary)
  2. Bones (bone pain)
  3. Groans (abdominal pain, nausea and vomiting)
  4. Thrones (sit on throne - polyuria or increased urination)
  5. Psychiatric overtones (Depression 30-40%, anxiety, cognitive dysfunction, coma)
  6. Other symptoms can include fatigue, anorexia, nausea, vomiting and pancreatitis (inflammation of the pancreas).
  7. Abnormal heart rhythms can result and are associated with abnormal ECG findings
"If in doubt get your calcium levels checked; prevention is better than cure."

4 comments:

  1. That seems a very high dose of calcium daily. Most multi-vits. have some calcium in them, 100 or 200 mg daily. Do you think these could cause calcium overdose when taken with 5000iu of vit D3?

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  2. Re: "That seems a very high dose of calcium daily."

    I agree; there is no need for someone with MS to be on such a high level of calcium intake.

    Re: "Most multi-vits. have some calcium in them, 100 or 200 mg daily. Do you think these could cause calcium overdose when taken with 5000iu of vit D3?"

    Very unlikely, unless it unmasks one the conditions associated with high calcium; typically subclinical primary hyperparathyroidism (quite a common condition) or sarcoidosis (one the most common MS mimics).

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  3. My daughter takes 5000 units vit D every day and no calcium. But her calcium level had gone up to 10.1 (upper end of normal) and it alarmed her neurologist, who wantef to stop vit D.
    The high calcium level was probably because of abnormally hard water. We fixed the water purifier and on testing again a few months later her calcium was 9.7 (vit d level had gone up)

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  4. If you have enough vitamin d you probably don't need a calcium supplement you can get the calcium from your diet. The blood calcium is likely to rise as you take vitamin d supplements because all the mechanisms (mainly the parathyroid but also high levels of 1,25(OH)D) the body has turned on to cope with the lack of 25(OH)D will take time to turn off.

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