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    Katherine Zeratsky, R.D., L.D.

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Mayo Clinic Health Manager

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Question

Vitamin D toxicity: What if you get too much?

What is vitamin D toxicity, and should I worry about it since I take supplements?

Answer

from Katherine Zeratsky, R.D., L.D.

Vitamin D toxicity, also called hypervitaminosis D, is a potentially serious but treatable medical condition that occurs when you get too much vitamin D.

Vitamin D toxicity usually results from taking an excessive amount of vitamin D supplements — not from your diet or too much sun exposure. That's because your body produces only a limited amount of vitamin D from sun exposure, and even fortified foods don't contain large amounts of vitamin D. Although vitamin D toxicity is rare even among people who take supplements, you may be at greater risk if you have health problems, such as liver or kidney conditions, or if you take thiazide-type diuretics.

The main consequence of vitamin D toxicity is a buildup of calcium in your blood (hypercalcemia), causing symptoms such as:

  • Nausea
  • Vomiting
  • Poor appetite
  • Constipation
  • Weakness
  • Confusion
  • Heart rhythm abnormalities
  • Kidney stones

Treatment of vitamin D toxicity may include:

  • Stopping vitamin D supplements
  • Restricting calcium intake
  • Medications
  • Hydration with fluids
  • Hospitalization in severe cases

Vitamin D is an essential nutrient. The Institute of Medicine recommends that children and adults up to age 50 get 200 international units (IU) of vitamin D daily. The recommendation for adults over age 50 is 400 to 600 IU daily. However, many health experts consider these recommendations to be too low. The American Academy of Pediatrics, for instance, now recommends that children and adolescents get 400 IU of vitamin D daily. Many experts now "unofficially" recommend that adults get as much as 1,000 to 2,000 IU of vitamin D daily. In addition, it's likely that the vitamin D guidelines will be revised upward.

Supplements can be a reasonable way to meet recommended levels — as long as you pay attention to how much you take.  And be sure to tell your doctor about any supplements you take.

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References
  1. Leu JP, et al. Vitamin D toxicity: Caveat emptor. Endocrine Practice. 2008;14:1188.
  2. Hemmelgarn M. Shedding light on vitamin D. American Journal of Nursing. 2009;109:19.
  3. Lee JH, et al. Vitamin D deficiency: An important, common, and easily treatable cardiovascular risk factor? Journal of the American College of Cardiology. 2008;52:1949.
  4. Dietary supplement fact sheet: Vitamin D. Office of Dietary Supplements. National Institutes of Health. http://ods.od.nih.gov/factsheets/vitamind.asp. Accessed June 2, 2009.
  5. Hathcock JN, et al. Risk assessment for vitamin D. American Journal of Clinical Nutrition. 2007;85:6.
  6. Brannon PM, et al. Overview of the conference "Vitamin D and Health in the 21st Century: An Update." American Journal of Clinical Nutrition. 2008;88(suppl):483S.
  7. Vitamin D. The Merck Manuals: The Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec01/ch004/ch004k.html. Accessed May 21, 2009.
  8. Wagner CL, et al. Prevention of rickets and vitamin D deficiency in infants, children and adolescents. Pediatrics. 2008;122:1142.
  9. Hensrud DD (expert opinion). Mayo Clinic, Rochester, Minn. June 17, 2009.

AN02008

Aug. 22, 2009

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