Reactions 1313 - 7 Aug 2010

SErgocalciferol

Decreased appetite, weight loss and increasedINR, in an elderly patient: case report

An 84-year-old woman receiving oral ergocalciferol[vitamin D2] developed decreased appetite, weight lossand an increased INR following a prescription error [timesto reaction onsets not stated].

The woman, who was receiving warfarin, presented for amonthly INR check and was found to have an elevated INRof 5.0 (target 2.0–3.0). She reported a decreased appetiteand had lost approximately 27 lbs over the past 6 months.Her chart was reviewed and a medication error wasidentified. She had been diagnosed with vitamin Ddeficiency 6 months earlier and had been prescribed oralergocalciferol 50 000 units weekly. However, for the past2 months, she had been receiving ergocalciferol50 000 units daily due to a prescription error. Her serumvitamin D level had increased to 100 ng/mL.

The woman was instructed to hold two of her warfarindoses, and then restart warfarin at a lower dose.Ergocalciferol was immediately discontinued and she wasinstructed to avoid nonprescription vitamin Dsupplements. Six weeks after discovering the error, herserum vitamin D levels had decreased to 76.8 ng/mL.Four months after ergocalciferol discontinuation, herweight was stable and her appetite had normalised. Athyroid nodule was noted upon CT scan, which may havecontributed to her signs and symptoms; she declined abiopsy.

Author comment: "The pharmacist identified thepossibility that vitamin D toxicity was contributing todecreased appetite, and hence weight loss and increasedINR."Carlton S, et al. Vitamin D deficiency: Appropriate replenishment therapies andthe effects of vitamin D toxicity. Consultant Pharmacist 25: 171-177, No. 3, Mar2010. Available from: URL: http://dx.doi.org/10.4140/tcp.n.2010.171 -USA 803029756

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Reactions 7 Aug 2010 No. 13130114-9954/10/1313-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved