Hypercalcemia due to hypervitaminosis D: report of seven patients

Area of Science:

• Pediatrics
• Endocrinology
• Toxicology

Background:

• Vitamin D is essential for bone health, but excessive intake can lead to toxicity.
• Accidental or inappropriate prescription of high-dose vitamin D in infants is a growing concern.
• Understanding the clinical spectrum and management of vitamin D toxicity is critical for pediatricians.

Purpose of the Study:

• To describe the clinical manifestations, biochemical abnormalities, and treatment outcomes of vitamin D toxicity in young children.
• To highlight the potential risks associated with high-dose vitamin D supplementation in infants.
• To provide insights into the management strategies for hypercalcemia and related complications.

Main Methods:

• Retrospective case series of seven children (7.5-25 months) with vitamin D toxicity.
• Analysis of clinical symptoms, serum calcium, 25-hydroxyvitamin D [25(OH)D] levels, intact parathyroid hormone (iPTH), and urinary calcium/creatinine ratios.
• Review of treatment protocols including fluid therapy, corticosteroids, dietary calcium restriction, and bisphosphonates.

Main Results:

• All patients presented with hypercalcemia (12-16.8 mg/dl) and elevated 25(OH)D levels (>96 ng/ml).
• Common symptoms included constipation, decreased appetite, lethargy, polyuria, and dehydration.
• Five patients had nephrocalcinosis, and all showed hypercalciuria.

Conclusions:

• Vitamin D toxicity in infants can result from high-dose prescriptions for incorrect indications.
• Prompt recognition and multidisciplinary management are essential to mitigate severe complications like nephrocalcinosis.
• Careful monitoring and appropriate dosing of vitamin D are crucial in pediatric practice.