From the Guidelines
Vitamin D toxicity in pediatrics is likely to occur at doses exceeding 10,000 IU daily for prolonged periods, with a well-defined threshold for acute toxicity not established, but serum concentrations >375 nmol/L associated with acute hypercalcaemia and hyperphosphataemia 1. The tolerable upper intake levels for vitamin D in children vary by age, with recommendations including 1000 IU/day for infants ages 0-6 months, 1500 IU/day for infants ages 7-12 months, 2500 IU/day for children ages 1-3 years, 3000 IU/day for children ages 4-8 years, and 4000 IU/day for children and adolescents ages 9-18 years 1. Key points to consider in vitamin D supplementation in pediatrics include:
- Monitoring of serum 25(OH) vitamin D concentrations to ensure sufficiency, with levels > 50 nmol/L indicating sufficiency 1
- Regular assessment of serum calcium levels to prevent hypercalcemia
- Awareness of the symptoms of vitamin D toxicity, including nausea, vomiting, poor appetite, constipation, weakness, confusion, and kidney problems due to calcium deposition
- Immediate cessation of vitamin D supplementation and medical intervention if toxicity is suspected The main function of vitamin D is the regulation of calcium and phosphate, essential for bone health, and while other health effects have been discussed, high-quality evidence is not sufficient to support vitamin D supplementation for these outcomes 1. The recommended daily dose of vitamin D for children and adolescents is 400-600 IU, with higher doses potentially leading to toxicity 1.
From the Research
Vitamin D Toxicity in Pediatrics
- Vitamin D toxicity is a rare condition in pediatrics, but it can occur due to excessive intake of vitamin D supplements 2, 3.
- The permissible limits of vitamin D intake are not well understood by the public, which can lead to vitamin D toxicity (VDT) 2.
- VDT is defined as serum 25(OH)D levels exceeding 100 ng/mL (250 nmol/L) or hypervitaminosis D 2.
Clinical Presentation and Management
- Hypercalcemia is a common condition of vitamin D toxicity, which can be managed by discontinuing vitamin D intake, using activated charcoal, furosemide, prednisone, and calcitonin, and rehydration using intravenous sodium chloride 0.9% and dextrose fluid therapy 2.
- In severe cases, vitamin D toxicity can present with dramatic life-threatening symptoms, such as resistant hypercalcemia and hypertension 4.
- Treatment of hypercalcemia due to vitamin D toxicity may involve the use of glucocorticoids and bisphosphonates 5, 6.
Prevention and Monitoring
- Parents should be cautious when providing vitamin D supplements to their children, and healthcare providers should monitor serum 25-hydroxyvitamin D levels in infants and children receiving long-term vitamin D supplementation at or above the recommended upper intake level 3.
- Errors in manufacturing, formulation, or prescription of vitamin D supplements can lead to vitamin D toxicity, highlighting the need for careful monitoring and regulation of these products 3, 4.