[Vitamin D poisoning in infants: a preventable cause of hypercalciuria and nephrocalcinosis].
The established prophylaxis for vitamin D-deficient rickets today is 400 IU vitamin D3 given daily during the first year of life. With this regimen, vitamin D intoxication is a rare event. Nevertheless, we have recently seen 4 infants with vitamin D intoxication after a so called "stoss" prophylaxis, i.e. twice 300,000 units (7.5 mg) vitamin D3 orally within 4 weeks. One patient presented with failure to thrive due to marked hypercalcemia (3.9 mmol/l) and nephrocalcinosis, 2 patients showed medullary nephrocalcinosis on ultrasonography and one patient had gross hematuria and spontaneous passage of a calculus. Three patients had massive hypercalciuria (calcium/creatinine ratio 1.8-4.8 mol/mol, normal less than 1). The 25 (OH) vitamin D3 plasma levels, measured only in 2 patients, were strikingly increased (270 and 158 nmol/l, respectively, normal 25-80). Urinary calcium excretion slowly decreased to normal values on a low calcium diet and high fluid intake. Nephrocalcinosis, however, persisted in 2 patients and showed a slight progression ultrasonographically in one patient. The short time interval between vitamin D administration and onset of symptoms and the subsequent clinical course provide strong evidence that hypercalciuria and nephrocalcinosis were due to vitamin D "stoss" prophylaxis in all four cases. In conclusion, there is no indication for vitamin D "stoss" prophylaxis for vitamin D-deficient rickets in infants. Vitamin D intoxication still has to be considered as a possible cause of hypercalciuria.
Hoppe
B
B
Universitäts-Kinderklinik, Zürich.
Gnehm
H E
HE
Wopmann
M
M
Neuhaus
T
T
Willi
U
U
Leumann
E
E
D002112:Calcifediol / Q000097:blood; D002118:Calcium / Q000652:urine*; D002762:Cholecalciferol / Q000008:administration & dosage / Q000506:poisoning*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009397:Nephrocalcinosis / Q000139:chemically induced* / Q000000981:diagnostic imaging; D014463:Ultrasonography
D002762:Cholecalciferol; D002112:Calcifediol; D002118:Calcium
Vitamin-D-Intoxikation beim Säugling: eine vermeidbare Ursache von Hypercalciurie und Nephrocalcinose.