Open AccessHypercalcemia in Children Receiving Pharmacologic Doses of Vitamin D
Author(s) -
Michelle B. Vanstone,
Sharon E. Oberfield,
Laurel Shader,
Laleh Ardeshirpour,
Thomas O. Carpenter
Publication year - 2012
Publication title -
pediatrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.611
H-Index - 345
eISSN - 1098-4275
pISSN - 0031-4005
DOI - 10.1542/peds.2011-1663
Subject(s) - medicine , dosing , dose , vitamin d and neurology , rickets , pediatrics , reference daily intake , population , vitamin d deficiency , hypervitaminosis , physiology , intensive care medicine , pathology , environmental health
Vitamin D deficiency causes rickets, requiring vitamin D at doses greater than daily dietary intake. Several treatment regimens are found in the literature, with wide dosing ranges, inconsistent monitoring schedules, and lack of age-specific guidelines. We describe 3 children, ages 2 weeks to 2 and 9/12 years, who recently presented to our institution with hypercalcemia and hypervitaminosis D (25-hydroxyvitamin D levels >75 ng/mL), associated with treatment of documented or suspected vitamin D-deficient rickets. The doses of vitamin D used were within accepted guidelines and believed to be safe. The patients required between 6 weeks and 6 months to correct the elevated serum calcium, with time to resolution of hypercalcemia related to age and peak serum calcium, but not to peak 25-hydroxyvitamin D level. With recent widespread use of vitamin D in larger dosages in the general population, we provide evidence that care must be taken when using pharmacologic dosing in small children. With limited dosing guidelines available on a per weight basis, the administration of dosages to infants that are often used in older children and adults has toxic potential, requiring a cautious approach in dose selection and careful follow-up. Dosage recommendations may need to be reassessed, in particular, where follow-up and monitoring may be compromised.