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Treating vitamin D toxicity

Vitamin D toxicity presents with weight loss, malaise and fatigue, followed by anorexia nausea and vomiting, and patients so afflicted almost always have increased thirst, increased urination, and night-time urination.

Ever heard of 50,000 IU tablets of Ertron, or Deltalin or Davitin, or Dalsol? You may have if you went to doctor in the 1930s and 1940s. Some doctors of that time prescribed the above drugs, all of which were Vitamin D2, now prescribed as Drisdol. Apparently, some doctors of the time believed massive D2 doses helped arthritis.

This 1948 paper from Johns Hopkins is remarkable for the dosage the doctors prescribed for arthritis and for the toxicity those doses sometimes caused. In their series of 10 toxic patients, the dose ranged from a low to 150,000 IU/day to a high of 600,000 IU/day and it took anywhere from 2 to 18 months for these daily doses to cause clinical toxicity. Clinical toxicity was manifested by weight loss, malaise and fatigue, followed by anorexia, nausea and vomiting. (Note, if you have these symptoms you are not vitamin D toxic, unless you have been taking at least 50,000 IU per day for many months, which is definitely not recommended.)

All toxic patients in the above paper had high blood calcium—anywhere from 12.4 to 15 mg/dL—and 9 of 10 were anemic; all had evidence of kidney impairment. The two bone biopsies were both normal. Seven of the ten patients insisted their arthritis was improved by Vitamin D toxicity and most complained their arthritis returned several months after withdrawal of Vitamin D, return of said arthritic complaints coincided closely with the return to normal of blood calcium.

Treatment of toxicity was simple, stop the Vitamin D. None of the life-threatening corticosteroid treatment toxic patients are given today. Simply stop the Vitamin D, keep them out of the sun, have them drink 4 liters of water a day, and wait. The clinical symptoms disappear in several weeks. The blood calcium returns to normal in several months. Most patients continued to show evidence of some renal damage but that damage appeared to be improving over time. Unlike modern corticosteroid treatment of Vitamin D toxicity, nobody died.

Page last edited: 08 November 2010