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Review Question - QID 107035

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QID 107035 (Type "107035" in App Search)
A 37-year-old female presents to her primary care physician with constipation and abdominal pain. She notes that the pain has been present for several days and is not related to food. She also reports increased urinary frequency without incontinence, as well as increased thirst. She takes no medications, but notes taking vitamin supplements daily. Her vital signs are: BP 130/72 mmHg, HR 82 bpm, T 97.0 degrees F, and RR 12 bpm. Lab studies reveal: Na 139, K 4.1, Cl 104, HCO3 25, Cr 0.9, and Ca 12.4. Further studies show an increased ionized calcium, decreased PTH, and increased phosphate. What is the most likely cause of this patient's symptoms?

Vitamin deficiency



Vitamin overdose



Primary endocrine dysfunction



Plasma cell neoplasm



Inherited disorder



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This patient's clinical presentation is consistent with hypervitaminosis D.

The maximum recommended dose of vitamin D is 4,000 IU/day in patients >9 years old. Overdose is nearly always a result of vitamin supplementation, and symptoms typically appear after several months of ingesting more than the recommended amount. Common symptoms of vitamin D intoxication include constipation, hypercalcemia, abdominal pain, weight loss, polyuria, and polydipsia. Suggested treatment includes cessation of vitamin intake and supporative care.

Incorrect Answers:
Answer 1: Vitamin D deficiency is associated with hypocalcemia and rickets, not hypercalcemia.
Answer 3: Primary hyperaldosteronism typically presents with elevated blood pressures and low potassium, which this patient does not have.
Answer 4: Multiple myeloma typically presents in an older population and is associated with constitutional symptoms or pathologic fractures.
Answer 5: Familial benign hypercalcemia is typically asymptomatic.

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