Cargando…

Two cases of severe vitamin D(3) intoxication treated with therapeutic plasma exchange and high cut-off hemodialysis

We report on a 53-year-old female patient and a 33-year-old male patient presenting with life-threatening hypercalcemic crisis caused by self-induced vitamin-D intoxication. Both patients took high doses of vitamin D(3) supplements, cumulatively up to 2,500,000–10,000,000 I.U. over several months. A...

Descripción completa

Detalles Bibliográficos
Autores principales: Heister, David J., Bohnert, Bernhard N., Heyne, Nils, Birkenfeld, Andreas L., Artunc, Ferruh
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10333361/
https://www.ncbi.nlm.nih.gov/pubmed/36547775
http://dx.doi.org/10.1007/s40620-022-01543-2
_version_ 1785070636671959040
author Heister, David J.
Bohnert, Bernhard N.
Heyne, Nils
Birkenfeld, Andreas L.
Artunc, Ferruh
author_facet Heister, David J.
Bohnert, Bernhard N.
Heyne, Nils
Birkenfeld, Andreas L.
Artunc, Ferruh
author_sort Heister, David J.
collection PubMed
description We report on a 53-year-old female patient and a 33-year-old male patient presenting with life-threatening hypercalcemic crisis caused by self-induced vitamin-D intoxication. Both patients took high doses of vitamin D(3) supplements, cumulatively up to 2,500,000–10,000,000 I.U. over several months. Accordingly, serum 25-OH-vitamin D concentrations were increased to 663 and 1289 nmol/L (reference 50–175 nmol/L), respectively. As forced diuresis and bisphosphonates failed to correct recurrent hypercalcemia, we hypothesized that add-on extracorporeal treatments might help overcome the refractory situation. Considering the binding of vitamin D(3) metabolites to vitamin D-binding protein (VDBP, 59 kDa), we started extracorporeal treatments involving total plasma exchange with replacement by human albumin and by fresh frozen plasma, online hemodiafiltration and high cut-off hemodialysis. We found that in the former case, total plasma exchange with albumin and fresh frozen plasma and high cut-off hemodialysis lowered both 25-OH-vitamin D(3) and 1,25-OH-vitamin D(3,) whereas in the latter case total plasma exchange with albumin was found to more effectively remove vitamin D metabolites compared to high cut-off hemodialysis. In contrast, the amount of total plasma calcium removed by high cut-off hemodialysis was higher compared to total plasma exchange with albumin. During follow up, patients 1 and 2 achieved almost normal total plasma calcium and vitamin D concentrations after 355 and 109 days, respectively. These two cases suggest that extracorporeal treatments with high cut-off hemodialysis and total plasma exchange with albumin may be considered as add-on treatment in refractory cases of vitamin D(3)-induced hypercalcemia to lower plasma 25-OH-vitamin D(3) concentrations.
format Online
Article
Text
id pubmed-10333361
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Springer International Publishing
record_format MEDLINE/PubMed
spelling pubmed-103333612023-07-12 Two cases of severe vitamin D(3) intoxication treated with therapeutic plasma exchange and high cut-off hemodialysis Heister, David J. Bohnert, Bernhard N. Heyne, Nils Birkenfeld, Andreas L. Artunc, Ferruh J Nephrol Case Report We report on a 53-year-old female patient and a 33-year-old male patient presenting with life-threatening hypercalcemic crisis caused by self-induced vitamin-D intoxication. Both patients took high doses of vitamin D(3) supplements, cumulatively up to 2,500,000–10,000,000 I.U. over several months. Accordingly, serum 25-OH-vitamin D concentrations were increased to 663 and 1289 nmol/L (reference 50–175 nmol/L), respectively. As forced diuresis and bisphosphonates failed to correct recurrent hypercalcemia, we hypothesized that add-on extracorporeal treatments might help overcome the refractory situation. Considering the binding of vitamin D(3) metabolites to vitamin D-binding protein (VDBP, 59 kDa), we started extracorporeal treatments involving total plasma exchange with replacement by human albumin and by fresh frozen plasma, online hemodiafiltration and high cut-off hemodialysis. We found that in the former case, total plasma exchange with albumin and fresh frozen plasma and high cut-off hemodialysis lowered both 25-OH-vitamin D(3) and 1,25-OH-vitamin D(3,) whereas in the latter case total plasma exchange with albumin was found to more effectively remove vitamin D metabolites compared to high cut-off hemodialysis. In contrast, the amount of total plasma calcium removed by high cut-off hemodialysis was higher compared to total plasma exchange with albumin. During follow up, patients 1 and 2 achieved almost normal total plasma calcium and vitamin D concentrations after 355 and 109 days, respectively. These two cases suggest that extracorporeal treatments with high cut-off hemodialysis and total plasma exchange with albumin may be considered as add-on treatment in refractory cases of vitamin D(3)-induced hypercalcemia to lower plasma 25-OH-vitamin D(3) concentrations. Springer International Publishing 2022-12-22 2023 /pmc/articles/PMC10333361/ /pubmed/36547775 http://dx.doi.org/10.1007/s40620-022-01543-2 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Case Report
Heister, David J.
Bohnert, Bernhard N.
Heyne, Nils
Birkenfeld, Andreas L.
Artunc, Ferruh
Two cases of severe vitamin D(3) intoxication treated with therapeutic plasma exchange and high cut-off hemodialysis
title Two cases of severe vitamin D(3) intoxication treated with therapeutic plasma exchange and high cut-off hemodialysis
title_full Two cases of severe vitamin D(3) intoxication treated with therapeutic plasma exchange and high cut-off hemodialysis
title_fullStr Two cases of severe vitamin D(3) intoxication treated with therapeutic plasma exchange and high cut-off hemodialysis
title_full_unstemmed Two cases of severe vitamin D(3) intoxication treated with therapeutic plasma exchange and high cut-off hemodialysis
title_short Two cases of severe vitamin D(3) intoxication treated with therapeutic plasma exchange and high cut-off hemodialysis
title_sort two cases of severe vitamin d(3) intoxication treated with therapeutic plasma exchange and high cut-off hemodialysis
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10333361/
https://www.ncbi.nlm.nih.gov/pubmed/36547775
http://dx.doi.org/10.1007/s40620-022-01543-2
work_keys_str_mv AT heisterdavidj twocasesofseverevitamind3intoxicationtreatedwiththerapeuticplasmaexchangeandhighcutoffhemodialysis
AT bohnertbernhardn twocasesofseverevitamind3intoxicationtreatedwiththerapeuticplasmaexchangeandhighcutoffhemodialysis
AT heynenils twocasesofseverevitamind3intoxicationtreatedwiththerapeuticplasmaexchangeandhighcutoffhemodialysis
AT birkenfeldandreasl twocasesofseverevitamind3intoxicationtreatedwiththerapeuticplasmaexchangeandhighcutoffhemodialysis
AT artuncferruh twocasesofseverevitamind3intoxicationtreatedwiththerapeuticplasmaexchangeandhighcutoffhemodialysis