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correspondence

Indian Pediatr 2014;51: 63

Vitamin D Toxicity


Anju Virmani

Senior Consultant Endocrinologist, New Delhi.
Email: [email protected]


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.
 

 

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