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How Much Vitamin D is Too Much? A Case Report and Review of the Literature
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How much vitamin D3 can you take safely a day?
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How Much Vitamin D is Too Much? A Case Report and Review of the Literature

Sara De Vincentis et al. Endocr Metab Immune Disord Drug Targets. 2021.

Free PMC article

Abstract

Background: The beneficial effects of vitamin D, together with the high prevalence of vitamin D deficiency, have led to an expanding use of vitamin D analogues. While inappropriate consumption is a recognized cause of harm, the determination of doses at which vitamin D becomes toxic remains elusive.

Case presentation: A 56-year woman was admitted to our Hospital following a 3-week history of nausea, vomiting, and muscle weakness. The patient had been assuming a very high dose of cholecalciferol for 20 months (cumulative 78,000,000UI, mean daily 130,000UI), as indicated by a non-- conventional protocol for multiple sclerosis. Before starting vitamin D integration, serum calcium and phosphorus levels were normal, while 25OH-vitamin D levels were very low (12.25 nmol/L). On admission, hypercalcemia (3.23 mmol/L) and acute kidney injury (eGFR 20 mL/min) were detected, associated with high concentrations of 25OH-vitamin D (920 nmol/L), confirming the suspicion of vitamin D intoxication. Vitamin D integration was stopped, and in a week, hypercalcemia normalized. It took about 6 months for renal function and 18 months for vitamin D values to go back to normal.

Conclusion: This case confirms that vitamin D intoxication is possible, albeit with a high dose. The doses used in clinical practice are far lower than these and, therefore, intoxication rarely occurs even in those individuals whose baseline vitamin D serum levels have never been assessed. Repeated measurements of vitamin D are not necessary for patients under standard integrative therapy. However, patients and clinicians should be aware of the potential dangers of vitamin D overdose.

Keywords: Vitamin D; cholecalciferol; hypercalcemia.; intoxication; overdose; toxicity.

Figures

Fig. (1)

Temporal evolution of serum vitamin D (A), creatinine (B), PTH (C), serum calcium (D), and Calcium to Phosphorus ratio (E) during the ultra-high dose supplementation of cholecalciferol (grey area) ended at the moment of clinical intoxication, and during the subsequent follow-up. Grey area from January 2015 to September 2016 defines the period of supplementation with high doses of vitamin D. In box A: levels of vitamin D from March 2015 to September 2016 are above 375 nmol/L, but not assessed through dilution, and they are represented by the red dashed line. In boxes B, D and E: horizontal dashed lines represent the upper limit of normal ranges of creatinine, calcium, and Ca/P ratio. In box C: horizontal dashed lines represent the upper and the lower limits of normal range of PTH. Abbreviations: Ca, calcium; P, phosphorus; PTH, parathyroid hormone. (A higher resolution / colour version of this figure is available in the electronic copy of the article).

Fig. (2)

Flow-chart of the literature review.

Cited by

Impact of Vitamin D Supplementation on Multiple Sclerosis.

Gandhi F, Jhaveri S, Avanthika C, Singh A, Jain N, Gulraiz A, Shah P, Nasir F. Gandhi F, et al. Cureus. 2021 Oct 5;13(10):e18487. doi: 10.7759/cureus.18487. eCollection 2021 Oct. Cureus. 2021. PMID: 34754649 Free PMC article. Review.

References

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How much vitamin D3 can you take safely a day?

Unless your doctor recommends it, avoid taking more than 4,000 IU per day, which is considered the safe upper limit. Choose food over pills.

Can too much vitamin D3 hurt?

Vitamin D is important for your bones, muscles, nerves, immune system, and more. But if you get too much, it could lead to a rare and possibly serious condition called vitamin D toxicity. You may hear your doctor call it hypervitaminosis D. The condition can bring symptoms like weakness and vomiting.

Can I take 5000 IU of vitamin D3 everyday?

In summary, long-term supplementation with vitamin D3 in doses ranging from 5000 to 50,000 IUs/day appears to be safe.

How many mcg of D3 per day is too much?

Vitamin D toxicity can have devastating health effects, which may not show up until months or even years after starting to take high doses. Generally, it's not recommended to exceed the upper limit of safe intake, which is 4,000 IU (100 mcg) per day.

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