ZAFER PEKKOLAY, FARUK KILINÇ, ŞADİYE ALTUN TUZCU, ALPASLAN KEMAL TUZCU

Hipervitaminoz D Nadiren Hiperkalsemi Yapar: Yeni Kavram „‟Subklinik İntoksikasyon‟‟

Amaç: Klinik pratikte çok yüksek serum 25 OH vitamin D değerlerinde hiperkalsemi gözlenmeyebilmektedir. Bunun nedeni bilinmemektedir. Bu çalışmada amacımız çok yüksek serum 25 OH vitamin D düzeyi olan hastalardaki hiperkalsemi yüzdesini ortaya koymaktır. Gereç ve Yöntem: 1 Ocak 2016 ile 31 Ekim 2017 tarihleri arasında Dicle Üniversitesi Tıp Fakültesi Hastanesinde serum 25 OH vitamin D düzeyine bakılan 22996 hasta tarandı. Serum 25 OH vitamin D düzeyi >150 ≧g/L olan çalışmaya alındı. Bu hastaların eğer varsa veri tabanımızdaki kalsiyum, fosfor, kreatinin, albumin ve parathormon değerlerine bakıldı. Hipervitaminoz D hastalarındaki hiperkalsemi oranlarına bakıldı. Kullandıkları D vitamini preperatı kaydedildi. D vitamini HPLC yöntemiyle çalışıldı. Bulgular: Serum 25 OH vitamin D >150 ≧g/L olan toplam 27 hasta saptandı. Oran yaklaşık olarak binde bir (0.0013) idi. Ortalama yaş 56 ±20 (24-90) idi. Çalışmamızdaki 27 hastanın 21‘i Kadın(%78) 6‘sı Erkek (%12 ) idi. Serum 25 OH Vitamin D düzeyi ortalaması 184.81±35.37(150.51-279.64) ≧g/L idi, replasman sonrası serum 25 OH vitamin D düzeylerine ortalama 2.10±1.58 ay sonra bakılmıştı. Ortalama serum kalsiyum düzeyi 9.48±0.52(8.4-10.9) mg/dL idi, 1 hastanın serum kalsiyum değerleri normalin üstünde(10.9 mg/dl) saptandı. Serum 25 OH vitamin D düzeyi >150 ≧g/L olan hastalardaki hiperkalsemi yüzdesi 3.70 saptandı. Sonuç: Çoğu hastada çok yüksek serum 25 OH vitamin D düzeyleri hiperkalsemiyi göstermemektedir. D vitamini düzeyi toksikasyon düzeyinin üzerinde saptandığında kalsiyum ve fosfor kontrolü yapılmalıdır. Çok yüksek D vitamini düzeyi genelde gereğinden çok fazla ampul formu kullanımına bağlı görülmektedir. Hastaların yakın takibi ve uygun dozda tedavisi bu problemi çözecektir

Hypervitaminosis D Rarely Causes Hypercalcemia: The New Concept '' Subclinical Intoxication ''

Objective: In clinical practice, hypercalcemia may not be observed with very high serum 25 OH vitamin D levels. The reason for this is unknown. Our aim in this study is to reveal the percentage of hypercalcemia in patients with very high serum 25 OH vitamin D levels. Methods: Between January 1, 2016 and October 31, 2017, 22996 patients who were referred to hospital and examined 25 OH vitamin D levels from all patients were screened at the Dicle University Medical Faculty Hospital. Patients with 25 OH vitamin D levels> 150 μg / L were included in the study. The calcium, phosphorus, creatinine, albumin and parathormone values of these patients, if any, were checked. Rates of hypercalcemia in patients with hypervitaminosis D were evaluated. The vitamin D preparations they used were recorded. Serum 25 OH Vitamin D was measured by HPLC method. Results: A total of 27 patients with serum 25 OH vitamin D> 150 μg / L were detected. The ratio was approximately 1/1000 (0.0013). The mean age was 56 ± 20 (24-90) years. Twenty-one of the 27 patients in our study were female (78%) and 6 were male (12%). Serum 25 OH Vitamin D level averaged 184.81 ± 35.37 (150.51-279.64) μg / L, serum 25 OH vitamin D levels after replacement were measured after a mean of 2.10 ± 1.58 months. The mean serum calcium level was 9.48 ± 0.52 (8.4-10.9) mg / dL, and the serum calcium level of one patient was above normal (10.9 mg / dL). The percentage of hypercalcemia in patients with serum 25 OH vitamin D level> 150 μg / L was 3.70%. Conclusion: As a result, very high levels of vitamin D do not show hypercalcemia. When vitamin D level is above the level of toxicity, calcium and phosphorus control should be performed. Very high vitamin D levels are often attributed to too much ampoule use. Close follow-up and appropriate dose treatment of the patients will solve this problem.

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ISSN: 1309-3878
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 2009
Yayıncı: Düzce Üniversitesi Tıp Fakültesi Aile Hekimliği AD adına Yrd.Doç.Dr.Cemil Işık Sönmez