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Clinical Toxicology of Vitamin D in Pediatrics: A Review and Case Reports
Jutti Levita1, Gofarana Wilar1, Ika Wahyuni2
1Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Padjadjaran University, Sumedang 45363, Indonesia.
Insights
Vitamin D toxicity (VDT) is rare in children but can occur due to lack of education on safe intake limits. Management involves discontinuing supplements and supportive care.
Area of Science:
- Pediatric Toxicology
- Endocrinology
- Nutritional Science
Background:
- Vitamin D supplements are widely available OTC, but public awareness of safe intake levels is limited.
- This can lead to accidental Vitamin D toxicity (VDT) in pediatric populations.
- VDT is characterized by serum 25(OH)D levels exceeding 100 ng/mL (250 nmol/L), often termed hypervitaminosis D.
Purpose of the Study:
- To review the clinical toxicology of vitamin D in pediatrics.
- To provide insights into the mechanisms, clinical presentation, and management of VDT.
- To educate healthcare practitioners and the public on preventing and treating pediatric vitamin D poisoning.
Main Methods:
- Literature review focusing on clinical toxicology of vitamin D in children.
- Analysis of mechanisms underlying VDT and hypercalcemia.
- Compilation of case reports and established management strategies for VDT.
Main Results:
- Vitamin D toxicity can induce hypercalcemia through increased bone resorption, enhanced intestinal calcium absorption, and renal calcium retention.
- Decreased parathyroid hormone synthesis is also a consequence of elevated vitamin D levels.
- Management strategies include discontinuing vitamin D, activated charcoal, diuretics, corticosteroids, calcitonin, and fluid therapy.
Conclusions:
- Parents need greater awareness regarding safe vitamin D supplementation for children.
- Prompt recognition and management are crucial for pediatric vitamin D poisoning.
- Further public education on vitamin D intake limits is essential to prevent toxicity.
Abstract:
Intoxication of vitamin D is not a common case in pediatrics. Vitamin D supplements are sold as OTC drugs; however, there is a lack of public education about the permissible limits of vitamin D intake which may lead to vitamin D toxicity (VDT). This review aims to give insights to readers or practitioners about the clinical toxicology of vitamin D in pediatrics, which includes the mechanism of VDT, case reports, and the management of vitamin D poisoning. VDT refers to serum 25(OH)D levels, particularly when the level exceeds 100 ng/mL (250 nmol/L) or is defined as hypervitaminosis D. Hypercalcemia is a common condition of vitamin D toxicity. Vitamin D and its metabolites in moderate levels can induce hypercalcemia, as indicated by the elevation of osteoclastic bone resorption, the presence of calcium in renal tubules, intestinal calcium intake (through increased production of calcium-binding protein in enterocytes), and the decrease of parathyroid hormone synthesis. VDT in pediatrics can be managed by discontinuing vitamin D intake; using activated charcoal, furosemide, prednisone, and calcitonin; rehydration using intravenous sodium chloride 0.9%; and dextrose fluid therapy. It is important for parents to be more careful when providing vitamin D to their children.
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