A recent case report indicates that pharmacologic doses of vitamin D can cause hypercalcemia and hypervitaminosis D (Pediatrics 2012; 129: e1060-63). The three cases all document good reasons for instituting therapy: craniotabes, hypocalcemic seizures, and tibial bowing. The total dose that the patients received over 7-12 weeks ranged from 112,000 IU to 168,000 IU. The ages of the patients ranged from 2 weeks to 33 months. The peak abnormal calcium for all three patients was 11 mg/dL and the peak 25-hydroxy vitamin D was 102 ng/dL. There were no clinical symptoms in these three patients due to increased calcium. A fourth oh-by-the-way patient was described as well. This patient was receiving vitamin D for an “inappropriate indication” (failure to thrive) and had received 3.6 million IU without monitoring. This led to the development of a multitude of symptoms associated with a calcium level of 17.4 mg/dL.
My take-home points:
- If giving generous doses of vitamin D, obtain a followup calcium several weeks into therapy. However, pharmacologic doses of vitamin D for valid indications pose a very low risk.
- Excessive doses of vitamin D can be detrimental. (This last statement may be akin to the warning “hot coffee might cause a burn.”)
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