To the Editor.—
It is generally agreed that individuals at high risk for developing osteoporosis should ingest adequate amounts of calcium and vitamin D. Maintenance doses of approximately 400 units of vitamin D3 and 1 to 2 g of calcium are recommended in patients whose diet is inadequate in calcium. Unfortunately, it is not commonly realized that the physiological dose of vitamin D (approximately 400 units daily) is not generally available in the United States except in combination with other vitamins or with calcium. Therefore, if "vitamin D" is ordered, pharmacologic doses (25,000 to 50,000 units) may be dispensed, resulting in severe hypercalcemia. We have recently seen several cases of improper dosing with vitamin D.
Report of Cases.—
An 81-year-old normocalcemic woman was admitted for rehabilitation of a broken femur. Before admission she was taking a preparation containing 125 units of vitamin D and 500 mg of calcium carbonate
Goldman JM, Ahn Y, Wheeler MF. Vitamin D and Hypercalcemia. JAMA. 1985;254(13):1719. doi:10.1001/jama.1985.03360130051010