Poisoning with VD3 is objectively weird. It's not very effective. If she had used tetrahydrozoline eyedrops, he'd be a goner after one dose -- and, with his heart and electrolyte balance troubles, odds are that nobody would be the wiser. We therefore have to surmise that she didn't want to kill him, but wanted to keep him sick, reliant, and compliant.
But they have small children, which are supposed to take vitamin D supplement that comes in this kind of bottle. So it's both easy for her and probably easier to explain, however vitamin D comes in an oil suspension, not water, so it seems to me that it wouldn't mix well in water.
She could have put potassium in his water and vitamin D in oil and food. That seems more likely to me.
Edit come to think of it, they did find elevated vitamin D levels in the water so I guess it was somehow a water-soluble formula. Not sure why she mentioned potassium then.
Which is plausibly why she tried using those agents to poison him: instead of being suspicious it was seen as a very complicated medical case.
Here's what I asked sonnet for a friend:
---
Here's an ASCII diagram illustrating the relationship:
Sarcoidosis
|
v
Granulomas
|
v
1-alpha-hydroxylase ↑
|
v
25(OH)D ---------> 1,25(OH)2D ↑
^ |
| v |
v
Serum Calcium ↑
|
v
Hypercalcemia
- Sarcoidosis is a granulomatous disease characterized by the formation of granulomas in various organs, particularly the lungs.
- These granulomas contain activated macrophages that express high levels of 1-alpha-hydroxylase, the enzyme responsible for converting 25-hydroxyvitamin D (25(OH)D) to its active form, 1,25-dihydroxyvitamin D (1,25(OH)2D).
- The increased 1-alpha-hydroxylase activity leads to excessive production of 1,25(OH)2D, which is not regulated by the normal feedback mechanisms.
- 1,25(OH)2D enhances intestinal calcium absorption and bone resorption, leading to increased serum calcium levels.
- This process can result in hypercalcemia, a common complication in sarcoidosis patients.
- The excess 1,25(OH)2D also suppresses parathyroid hormone (PTH) production, which normally regulates calcium homeostasis.
- Importantly, the increased 1,25(OH)2D levels are not dependent on vitamin D intake or sun exposure, as the conversion occurs independently of the body's vitamin D status.
- This dysregulation can lead to a paradoxical situation where patients with sarcoidosis may have high 1,25(OH)2D levels but low or normal 25(OH)D levels.
Key points to remember:
- Granulomas in sarcoidosis are the source of increased 1-alpha-hydroxylase activity.
- This leads to excessive 1,25(OH)2D production, independent of normal regulatory mechanisms.
- The result is increased calcium absorption and potential hypercalcemia.
- Management often involves limiting calcium and vitamin D intake, and in some cases, using corticosteroids to suppress granuloma activity.