Intermittent high-dose vitamin D prophylaxis during infancy: effect on vitamin D metabolites, calcium, and phosphorus

Abstract

In infants receiving intermittent high dose vitamin D prophylaxis (600,000 IU ergocalciferol per dose orally) every 3-5 mo, the serum concentrations of vitamin D metabolites, calcium (Ca), and phosphorus (P) were determined before and 2 wk after each dose. The 25-hydroxyvitamin D (OHD) concentrations increased to well above normal but the values returned to the normal range before each subsequent dose. The 24,25- and 25,26-dihydroxyvitamin D ([OH]2D) levels followed a pattern similar to that of 25-OHD, and both were closely related to the latter (r = 0.85, p less than 0.005, and r = 0.84, p less than 0.005, respectively). The 1,25-(OH)2D concentrations did not vary in a consistent pattern and remained largely within the normal range. All infants had normal Ca levels before the first dose but 14 infants (34%) later had one or both Ca values above the upper normal limit of 2.80 mmol/L (2.81-3.32 mmol/L), indicating that the vitamin D doses were excessive despite the lack of accumulative increases in serum vitamin D concentrations.

The virtues of vitamin D—but how much is too much?

“…Only a decade ago, the majority of adult CKD patients were seldom prescribed vitamin D, but now some would argue that withholding its use is unethical! Yet, as nephrologists, we have much to learn from our own exuberant prescribing of medication like EPO and higher dialysis doses as well as from the history of vitamin D usage [10,41,49,103,104]. When ergocalciferol supplements first became available in the 1920s, high doses were indiscriminately prescribed for rheumatoid arthritis, tuberculosis, Paget's disease and even chilblains; however, ergocalciferol has since been shown not to have any beneficial effect on any of these conditions [103].…”

Consensus Development for the Supplementation of Vitamin D in Childhood and Adolescence

“…The European method in which a single or divided dose of up to 300,000 IU is administered orally or intramuscularly has been in use since the 1930s. Higher dose, or stoss therapy in well-nourished children, may be excessive and result in hypercalciuria and nephrocalcinosis [5].…”

Cross-sectional analysis of universal vitamin D supplementation in former East Germany during the first year of life

“…From 1947 children in East Germany received oral stoss-prophylaxis with 600,000 units of vitamin D2 at 1, 4, 7 and 11 months of age. Later this regimen was adjusted to 100,000 units of vitamin D3 to prevent hypercalcaemia [12,[19][20][21]. Under stoss-prophylaxis no cases of rickets were reported.…”