We read with interest the recent article [1] on a topic which is in
almost everybody’s mind. Unfortunately, the authors are completely
silent on a crucial aspect, i.e. iatrogenic toxicity. Of late, it is not
unusual to see prescriptions carrying advice for injectable Vitamin D, 6
lakh units intramuscular weekly for 4-6 doses, along with oral sachets
of 60,000 units weekly, for unspecified periods! A year ago, we admitted
a 4-month old baby who was prescribed 60000 units of vitamin D twice
daily for 4 months by a qualified pediatrician. The baby presented with
vomiting, a serum calcium of 17 mg/dL, and eventual nephrocalcinosis. In
addition, there may be unwitting over-prescription. There is now a
confusing multiplicity of preparations, with capsules of 1000 or 2000
units similar in appearance to capsules of 60000 units.
Another alarming tendency which we need to be beware
of, is to prescribe calcitriol indiscriminately. Calcitriol is needed
only in a small subset of patients, e.g. those who have
hypoparathyroidism or end stage renal failure. In others, it cause more
harm than good, by causing transient hypercalcemia and reducing the
body’s own PTH drive.
Reference
1. Balasubramanian S, Dhanalakshmi K, Amperazani S.
Vitamin D deficiency in childhood – a review of current guidelines on
diagnosis and management. Indian Pediatr. 2013;50:669-75.