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Soft Tissues
Published in Joseph Kovi, Hung Dinh Duong, Frozen Section In Surgical Pathology: An Atlas, 2019
DIFFERENTIAL DIAGNOSIS: ClinicalAlthough calcinosis universalis occurs mainly in patients below age of 20, in contrast to tumoral calcinosis, there are systemic manifestations, muscle atrophy, contractures, etc., present. Calcinosis circumscripta affects primarily middle-aged women. Vitamin-D intoxication may present with soft tissue calcification, but serum and urinary calcium levels are high. The radiologic appearance of calcifications in secondary hyperparathyroidism (renal osteodystrophy) is fairly similar to that found in tumoral calcinosis.251MicroscopicMarkedly distended soft tissue spaces filled with fine or coarse calcium granules, is a rather characteristic finding. Occasionally, epitheloid cells and foreign body multinucleated giant cells may be present.
Additional Supplements That Support Glycemic Control and Reduce Chronic Inflammation
Published in Robert Fried, Richard M. Carlton, Type 2 Diabetes, 2018
Robert Fried, Richard M. Carlton
A review in the journal Anticancer Agents in Medicinal Chemistry reported the following on the safety of vitamin D3 supplementation: The concept of vitamin D3 safety concerns two aspects: the safe tolerable UL method and adequate circulating 25-hydroxyvitamin D (25[OH]D) levels. Oral vitamin D intakes up to 250 μg/day have not been associated with harm. Hypercalcemia, the hallmark of vitamin D intoxication, may occur only if circulating 25(OH)D levels are consistently above 375–500 nmol/L.
Clinical Evaluation of Hypercalcaemia
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Except in cases of obvious humoral hypercalcaemia of malignancy, serum vitamin D should be performed routinely in non-PTH dependent hypercalcaemia. An elevated 25-hydroxycholecalciferol [25(OH)D] is indicative of excessive ingestion of vitamin D. There is no agreement on the level of 25(OH)D at which hypercalcaemia typically occurs. Many experts define vitamin D intoxication as a value greater than 375 nmol/L (150 ng/mL).13
Vitamin D: sources, physiological role, biokinetics, deficiency, therapeutic use, toxicity, and overview of analytical methods for detection of vitamin D and its metabolites
Published in Critical Reviews in Clinical Laboratory Sciences, 2022
Jiří Janoušek, Veronika Pilařová, Kateřina Macáková, Anderson Nomura, Jéssica Veiga-Matos, Diana Dias da Silva, Fernando Remião, Luciano Saso, Kateřina Malá-Ládová, Josef Malý, Lucie Nováková, Přemysl Mladěnka
Since the number of scientific reports on the potential benefits of vitamin D on different diseases is large and continues to increase, fortified food and vitamin D supplements have become easily obtainable over-the-counter in pharmacies, supermarkets, and online stores [296], and this market has been growing all over the world [301]. As such, in addition to iatrogenic factors, the causes of vitamin D overdose and subsequent toxicity are mainly associated with self-medication, accidental incorrect doses (for instance due to prescribing errors), or the use of unlicensed and/or poorly standardized products [289,295]. The latter was associated with the urgent need for vitamin D products to be certified by highly harmonized analytical methodologies [302]. Several validated methods and standardized protocols have been provided by international authorities, including the United States Pharmacopeia in the Vitamin D Assay Monography (581) [303] and European Standard approved by the European Committee on Standardization [304], to increase the quality of dietary supplements. These guidelines summarize analytical procedure conditions for various formulations, which are described in detail with acceptable tolerance limits [305]. Nevertheless, it should be emphasized, that the regulation and quality control of dietary supplements differ in individual countries based on the current law and recommendations, thus in some cases, there is a lack of dietary supplement control that can lead to poor quality products. Indeed, two adult cases of chronic vitamin D intoxication caused by manufacturing errors have been reported [289,295]. In both cases, the real vitamin D level was 1000-fold higher than the daily dose level declared by the manufacturer, which points to a failure in quality control.
Vitamin D supply in shift working nurses
Published in Chronobiology International, 2018
Martin Lehnert, Alexandra Beine, Katarzyna Burek, Simone Putzke, Stephan Schlösser, Dirk Pallapies, Thomas Brüning, Thomas Behrens, Sylvia Rabstein
Independent health authorities recommend a total 25-hydroxyvitamin D (25[OH]D) serum level of at least 20 ng/mL (50 nmol/L) to prevent rickets. Levels below 20 ng/mL are considered deficient and supplementation is recommended (National Institutes of Health 2016; German Nutrition Society 2012). Hypercalcemia is responsible for most symptoms of vitamin D intoxication due to prolonged high dosage intake (Alshahrani and Aljohani 2013). As the US Institute of Medicine stated in 2010, serum concentrations above 50 ng/mL (150 nmol/L) can be associated with adverse effects.