Review Question - QID 104343

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Vitamin D Excess Causes QID: 104343 (M2.NT.15.18)

QID 104343 (Type "104343" in App Search)

A 55-year-old woman who is an established patient presents to your office. She is complaining of increased urination and increased thirst. She has recently began taking several over-the-counter vitamins and supplements. On further review, she reports she has also been having abdominal pain and constipation. She denies significant weight changes. Her fingerstick blood glucose in your office is 96 mg/dL.

Which of the following test is most likely to provide the diagnosis?

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Pyridoxine levels

2/32

Niacin levels

0/32

Calcium level

66%

21/32

Hemoglobin A1C

22%

7/32

Free T4 levels

1/32

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This patient is most likely demonstrating the symptoms of vitamin D toxicity.

Vitamin D toxicity can be seen with ingestion of supplements containing very high levels of vitamin D, usually greater than about 10 times the RDA. A similar presentation may also be seen in sarcoidodis due to increased production of vitamin D by epithelioid macrophages. Presentation may include polyuria, polydipsia, nocturia, hypercalcemia, and hypercalciuria. Abdominal pain, nausea, vomiting, and occasionally pancreatitis can be seen.

Illustration A depicts the major steps in the metabolism of vitamin D, including successive hydroxylation steps.

Incorrect Answers:
Answer 1: Pyridoxine toxicity typically includes tachypnea and sensory neuropathies.
Answer 2: Niacin toxicity frequently includes flushing, pruritus, and vasodilation.
Answer 4: Elevated blood glucose is less likely to be the cause here, given the patients normal finger stick blood glucose.
Answer 5: Abnormalities in thyroid hormone levels are less likely. Hyperthyroidism would be more likely to cause diarrhea than constipation. Hypothyroidism would be likely to present with weight gain.

ILLUSTRATIONS: