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Two cases of severe vitamin D3 intoxication treated with therapeutic plasma exchange and high cut-off hemodialysis.
J. Nephrol. 36, 1461-1467 (2022)
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 D3 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 D3 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 D3 and 1,25-OH-vitamin D3, 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 D3-induced hypercalcemia to lower plasma 25-OH-vitamin D3 concentrations.
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Publication type
Article: Journal article
Document type
Scientific Article
Keywords
Acute Kidney Injury ; Hypercalcemia ; Plasma Exchange ; Renal Dialysis ; Vitamin D
ISSN (print) / ISBN
1120-3625
e-ISSN
1724-6059
Journal
Journal of Nephrology
Quellenangaben
Volume: 36,
Issue: 5,
Pages: 1461-1467
Publisher
Springer
Publishing Place
Tiergartenstrasse 17, D-69121 Heidelberg, Germany
Non-patent literature
Publications
Reviewing status
Peer reviewed
Grants
Projekt DEAL