Hypercalcemia in children receiving pharmacologic doses of vitamin D

Area of Science:

• Pediatrics
• Endocrinology
• Nutritional Science

Background:

• Vitamin D deficiency is a common cause of rickets, necessitating supplementation.
• Current treatment guidelines for vitamin D deficiency rickets lack age-specific dosing and consistent monitoring protocols.
• Pharmacologic vitamin D dosing is increasingly used, raising concerns about safety in pediatric populations.

Observation:

• Three pediatric patients (2 weeks to 2.75 years) presented with hypercalcemia and hypervitaminosis D (25-hydroxyvitamin D >75 ng/mL).
• These adverse events occurred despite vitamin D doses within accepted guidelines for treating rickets.
• Resolution of hypercalcemia took 6 weeks to 6 months, correlating with age and peak serum calcium, not peak vitamin D levels.

Findings:

• The study highlights the potential for toxic vitamin D levels and hypercalcemia in young children, even with seemingly safe dosages.
• Current dosing recommendations may not adequately account for weight-based differences in infants and older children.
• The time to normalize calcium levels was influenced by patient age and initial calcium levels.

Implications:

• There is a need for reassessed, age-specific vitamin D dosage recommendations for pediatric rickets treatment.
• Clinicians must exercise caution with pharmacologic vitamin D dosing in infants and young children.
• Close monitoring and follow-up are essential, especially when adherence to monitoring schedules may be compromised.