Irfan Tramboo
SRINAGAR, Jan 4: A study conducted by doctors at SKIMS, Soura has found that Vitamin D Toxicity can manifest with Altered Mental Status (AMS) in elderly people while noting that Vitamin D should be prescribed only after checking the serum levels and frequently monitoring its presence.
The authors of the study have stated that the research has been carried out to establish vitamin D toxicity (VDT) as an underlying cause of AMS in elderly patients presenting to the hospital.
“This was a descriptive case study conducted at a tertiary care university hospital, SKIMS, from January 2015 to March 2020 for a total duration of five years,” they said.
The study has been conducted by the doctors of the Department of Internal and Pulmonary Medicine, SKIMS and has been published in the Cureus which is also known as the Cureus Journal of Medical Science.
As per the study, around 25-30% of elderly patients present to emergency departments (ED) with altered mental status (AMS), with hypercalcemia being one of the metabolic causes.
“Elderly patients, due to their multiple vulnerability factors and relative homeostenosis, are susceptible to alterations in mental state at even milder grades of hypercalcemia.”
The study has noted that there is a trend of overzealous prescriptions of higher doses of vitamin D in elderly patients for various ailments, which often exceeds the requirements of the patients.
“Elderly patients (aged over 60 years) who were admitted with VDT as a cause for underlying hypercalcemia were included. The evaluation included patient history regarding the dosage of vitamin D received, route of administration, and biochemical parameters, such as serum calcium, intact parathyroid hormone 25-hydroxy vitamin D [25(OH)D], and albumin,” the study said.
It noted that AMS is a common complaint among elderly patients who present to the emergency department (ED) and that up to 25-30% of elderly patients present to ED with AMS, with the majority of the causes ranging from delirium to stupor to coma.
“Urinary tract infections and pneumonia account for the majority of known causes of acute brain dysfunction in the geriatric population.”
The study has underlined that in recent years, general practitioners have been more frequently ordering tests for underlying vitamin D deficiency and prescribing significantly more oral or injectable vitamin D to treat the condition trend of zealous prescription, particularly to the geriatric population, may result in VDT, “which can manifest as AMS.”
The researchers stated that the study was carried out in the Kashmir valley, where vitamin D deficiency is known to be rampant. “Its presentation varies from drowsiness to a comatose state depending on the severity and rate of hypercalcemia, and this is especially concerning in elderly patients who can develop AMS even at lower levels of serum calcium.”
In light of the observations, the study said, prompted the doctors to look into VDT as a possible cause of AMS in elderly patients who presented to the hospital.
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