BACKGROUND. Vitamin D has been added to milk in the United States since the 1930s to prevent rickets. We report the unusual occurrence of eight cases of vitamin D intoxication that appear to have been caused by excessive vitamin D fortification of dairy milk. METHODS. Medical records were reviewed and a dietary questionnaire was sent to eight patients who had unexplained hypervitaminosis D. Vitamin D analyses with high-performance liquid chromatography were performed on samples of the patients' serum, the dairy milk they drank, and the vitamin D concentrate added to the milk. RESULTS. All eight patients drank milk produced by a local dairy in amounts ranging from 1/2 to 3 cups (118 to 710 ml) daily. All had elevated serum 25-hydroxyvitamin D concentrations (mean [+/- SD], 731 +/- 434 nmol per liter [293 +/- 174 ng per milliliter]). Six of the eight patients had elevated serum vitamin D3 concentrations. Of the eight patients, seven had hypercalcemia and one had hypercalciuria but normocalcemia (mean serum calcium, 3.14 +/- 0.51 mmol per liter [12.6 +/- 2.1 mg per deciliter]). Analysis of the dairy's vitamin D-fortified milk revealed concentrations of vitamin D3 (cholecalciferol) that ranged from undetectable to as high as 232,565 IU per quart (245,840 IU per liter). An analysis of the concentrate that was used to fortify the milk, labeled as containing vitamin D2 (ergocalciferol), revealed that it contained vitamin D3. CONCLUSIONS. Hypervitaminosis D may result from drinking milk that is incorrectly and excessively fortified with vitamin D. Milk that is fortified with vitamin D must be carefully monitored.
Source Information
Division of Endocrinology, Beth Israel Hospital, Boston, MA.
This article has been cited by other articles:
Kimball, S., Vieth, R.
(2008). Self-prescribed high-dose vitamin D3: effects on biochemical parameters in two men. Ann Clin Biochem
45: 106-110
[Abstract][Full Text]
Hathcock, J. N, Shao, A., Vieth, R., Heaney, R.
(2007). Risk assessment for vitamin D. Am. J. Clin. Nutr.
85: 6-18
[Abstract][Full Text]
Vieth, R.
(2006). Critique of the Considerations for Establishing the Tolerable Upper Intake Level for Vitamin D: Critical Need for Revision Upwards. J. Nutr.
136: 1117-1122
[Abstract][Full Text]
Garland, C. F., Garland, F. C., Gorham, E. D., Lipkin, M., Newmark, H., Mohr, S. B., Holick, M. F.
(2006). The Role of Vitamin D in Cancer Prevention. Am. J. Public Health
96: 252-261
[Abstract][Full Text]
Barrueto, F. Jr,, Wang-Flores, H. H., Howland, M. A., Hoffman, R. S., Nelson, L. S.
(2005). Acute Vitamin D Intoxication in a Child. Pediatrics
116: e453-e456
[Abstract][Full Text]
Lichtenstein, A. H., Russell, R. M.
(2005). Essential Nutrients: Food or Supplements?: Where Should the Emphasis Be?. JAMA
294: 351-358
[Abstract][Full Text]
Holick, M. F
(2004). Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am. J. Clin. Nutr.
80: 1678S-1688S
[Abstract][Full Text]
Lloyd, M. A., Zou, J., Farnsworth, H., Ogden, L. V., Pike, O. A.
(2004). Quality at Time of Purchase of Dried Milk Products Commercially Packaged in Reduced Oxygen Atmosphere. J DAIRY SCI
87: 2337-2343
[Abstract][Full Text]
Tryfonidou, M. A., Stevenhagen, J. J., van den Bemd, G.J.C.M., Oosterlaken-Dijksterhuis, M. A., DeLuca, H. F., Mol, J. A., van den Brom, W. E., van Leeuwen, J.P.T.M., Hazewinkel, H.A.W.
(2002). Moderate Cholecalciferol Supplementation Depresses Intestinal Calcium Absorption in Growing Dogs. J. Nutr.
132: 2644-2650
[Abstract][Full Text]
Lips, P.
(2001). Vitamin D Deficiency and Secondary Hyperparathyroidism in the Elderly: Consequences for Bone Loss and Fractures and Therapeutic Implications. Endocr. Rev.
22: 477-501
[Abstract][Full Text]
Koutkia, P., Chen, T. C., Holick, M. F.
(2001). Vitamin D Intoxication Associated with an Over-the-Counter Supplement. NEJM
345: 66-67
[Full Text]
Hollis, B. W.
(2000). Comparison of Commercially Available 125I-based RIA Methods for the Determination of Circulating 25-Hydroxyvitamin D. Clin. Chem.
46: 1657-1661
[Abstract][Full Text]
Vieth, R.
(1999). Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am. J. Clin. Nutr.
69: 842-856
[Abstract][Full Text]
Kerr, D.N.S
(1997). Hypercalcemia and metastatic calcification. Cardiovasc Res
36: 293-297
[Full Text]
Chen, T. C., Shao, Q., Heath, H., Holick, M. F.
(1993). An Update on the Vitamin D Content of Fortified Milk from the United States and Canada. NEJM
329: 1507-1507
[Full Text]
(1992). HAZARDS OF VITAMIN D SUPPLEMENTATION OF MILK. JWatch General
1992: 7-7
[Full Text]
