Ergocalciferol overdose Hypercalcaemia and kidney iii disorders treated with glutethimide: case report

Following ingestion of ergocalciferol [calciferol]1S0,000 IU/day, a 77-year­old woman presented with confusion . Investigations revealed hypercalcaemia (plasma calcium 3.S2 mmol/L) and impaired renal function (plasma creat inine 229 pmoIjL). Prednisolone 1Smg tid was withdrawn after 10 days as it failed to restore normocalcaemia. Plasma calcium levels remained elevated for 14 days, and glutethimide SOO mg at night was started. Total serum concentrations of 2S-hydroxyvitamin 0 and 1 ,2S-dihydroxyvitamin 0 were 10S0 nmoljL and 260 pmoljL, respectively.

Eight days after glutethimide administration, gamma-glutamyl transferase activity rose above normal limits, peaking at 90 U/L on days 18-22. On day 13, plasma calcium fell to normal levels. Serum 1,2S-dihydroxyvitamin 0 began to fall within 4 days and was 70 pmol/L after 8 days. Total serum 2S-hydroxyvitamin o did not alter until hepatic enzyme induction; thereafter it fell slowly. The patient remained normocalcaemic and her renal function and confused state improved.

'Our results show that glutethimide causes supra-normal concentrations of 1,25-dlhydroxyvltamln D to fall rapidly, with correction of hypercalcaemia and symptomatic improvement. '

Iqbal SJ. Taylor WHo Fraher LJ. O'R,ordan JLH Glutethlmldme and circulating 1.25· d,hydroxyv,tam,n 0 In vitamin 0 IntoXication British Medical Journal 297 902. 8 Oct 1988 ,..,

8 REACTIONSS 29 Ocl 1988 0157-7271 / 88/ 1029.0008/ 0$0 1.00/ 0 © ADIS Press