| Management |
Vitamin D analogs should not be used in combination with each other or with pharmacologic doses of vitamin D. Serum calcium and phosphorus levels must be closely monitored during therapy with a vitamin D analog, especially early in treatment during dosage adjustment. The serum calcium X phosphorus product should be maintained at less than 55 in patients with chronic kidney disease and should not be allowed to exceed 70 in any patient. An estimate of daily dietary calcium intake should be made and the intake adjusted when indicated. Patients should be advised to avoid an abrupt increase in dietary calcium intake, as it may trigger hypercalcemia, and to contact their physician if they experience early symptoms of vitamin D intoxication associated with hypercalcemia such as weakness, fatigue, headache, somnolence, vertigo, tinnitus, anorexia, nausea, vomiting, constipation, dry mouth, metallic taste, muscle pain, bone pain, ataxia, and hypotonia. Late symptoms may include polyuria, polydipsia, weight loss, nocturia, conjunctivitis, photophobia, rhinorrhea, pruritus, hyperthermia, decreased libido, and cardiac arrhythmias. Radiographic evaluation of suspect anatomical regions may be useful in the early detection of hypercalcemia. If hypercalcemia develops, treatment with vitamin D and any calcium product should be stopped immediately. |
