A Case of Metabolic Encephalopathy Triggered by Food Supplements

Abstract

A 59-year-old Caucasian female with history of multiple sclerosis (MS), osteoporosis and breast cancer presented with weakness, constipation, confusion and short term memory loss. Her metabolic profile showed pre renal azotemia and severe hypercalcemia (16.2 mg%). Aggressive medical management led to favorable resolution of her symptoms. A complete diagnostic work up for the etiology of hypercalcemia was then performed. PTH levels were suppressed at 5.6 pg / mL arousing suspicion for hypercalcemia due to malignancy (prior history of breast cancer vs. new primary). PTHrP (0.8 pmol / L), TSH (0.623 IU / L) and free T4 (2.87 ng / dL) were within normal limits. 25- hydroxy Vitamin D level was high at 96 ng / mL, while 1-25 dihydroxy vitamin D was 28 pg / mL. Review of her medication list showed daily intake of 800 units of vitamin D. The patient denied overdosing on prescription vitamin D but later admitted that she was ingesting an expensive naturally derived gel preparation containing about 16,000 IU of vitamin D3 daily. This was one of several alternative medications prescribed to her by an online practitioner for her MS and osteoporosis. Patient was counseled on potential side effects of excessive vitamin D supplementation and these were withheld at the time of discharge. J Endocrinol Metab. 2013;3(1-2):38-40 doi: https://doi.org/10.4021/jem146w