Vitamin D Supplementation and Risk of Toxicity in Pediatrics: A Review of Current Literature

Abstract

Although rare, cases of vitamin D intoxication that present with dramatic life-threatening symptoms still occur in children. Moreover, recent studies in infants raise a potential need for monitoring vitamin D levels when doses at or above the currently recommended upper range are used. Further studies are needed to clarify these findings. The Drugs and Therapeutics Committee of the Pediatric Endocrine Society suggests obtaining serum 25-hydroxyvitamin D levels in infants and children who receive long-term vitamin D supplementation at or above the upper level intake that is currently recommended.

Probability of Vitamin D Deficiency by Body Weight and Race/Ethnicity

“…However, actual cases of vitamin D toxicity are extremely rare and typically result in complete recovery after the source of excessive vitamin D is discovered and removed. 31,32 In general, reported cases result from compounding or manufacturing errors that could happen with any drug or supplement and are not specific to vitamin D. Concerns about vitamin D's toxicity date to the 1950s, when unusual cases of idiopathic infantile hypercalcemia occurred soon after foods were fortified with vitamin D. Recent genetic studies have clarified that idiopathic infantile hypercalcemia is related to a mutation in the CYP24A1 gene, which produces the enzyme that metabolizes 25(OH)D and 1,25-dihydroxyvitamin D. 33 Individuals with this mutation or with diseases known to lead to high calcium concentrations, such as sarcoidosis and lymphoma, should receive vitamin D supplementation only under medical supervision.…”

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

“…As suggested by Abrams [36] and Paxton et al [6] the decision to recommend higher doses of vitamin D should depend on whether future studies provide evidence for the importance of vitamin D levels higher than 50 nmol/L for the prevention of extra skeletal health-risks. Side effects observed in vitamin D sensible infants include tissue calcification and nephrocalcinosis [10,[37][38][39].…”

“…This is controversial for sunny countries like Spain or Australia [6,9]. It is recommended to monitor 25(OH)D levels before starting vitamin D supplementation at doses higher than the recommended upper intake level for a longer period of time [10].…”

Reposição de vitamina D nativa: indicação à luz das evidências científicas atuais

“…19 A intoxicação por vitamina D foi relatada em adultos recebendo mais de 60.000 UI/dia, ou devido a erros na fabricação, formulação ou prescrição. 20 Os sintomas da intoxicação aguda devem-se à hipercalcemia e hipercalciúria, e incluem confusão mental, poliúria, polidipsia, anorexia, vômitos e fraqueza muscular. A intoxicação pode causar nefrocalcinose, desmineralização óssea e dor.…”

“…O tratamento é o mesmo estabelecido para hipercalcemia. 20 Em relação à suplementação de vitamina D e Ca e o desenvolvimento de litíase renal, existem resultados controversos na literatura. Em um estudo experimental, a administração de vitamina D e Ca diminuiu significativamente a formação de cálculos e reduziu a calciúria, sugerindo uma interferência benéfica na fisiopatologia litogênica.…”