title: Hypercalcemia in children receiving pharmacologic doses of vitamin D.
abstract: Vitamin D deficiency causes rickets, requiring vitamin D at doses greater than daily dietary intake. Several treatment regimens are found in the literature, with wide dosing ranges, inconsistent monitoring schedules, and lack of age-specific guidelines. We describe 3 children, ages 2 weeks to 2 and 9/12 years, who recently presented to our institution with hypercalcemia and hypervitaminosis D (25-hydroxyvitamin D levels >75 ng/mL), associated with treatment of documented or suspected vitamin D-deficient rickets. The doses of vitamin D used were within accepted guidelines and believed to be safe. The patients required between 6 weeks and 6 months to correct the elevated serum calcium, with time to resolution of hypercalcemia related to age and peak serum calcium, but not to peak 25-hydroxyvitamin D level. With recent widespread use of vitamin D in larger dosages in the general population, we provide evidence that care must be taken when using pharmacologic dosing in small children. With limited dosing guidelines available on a per weight basis, the administration of dosages to infants that are often used in older children and adults has toxic potential, requiring a cautious approach in dose selection and careful follow-up. Dosage recommendations may need to be reassessed, in particular, where follow-up and monitoring may be compromised.
authors.affiliation: Department of Pediatrics (Endocrinology), Yale University School of Medicine, New Haven, CT 06520-8064, USA.
authors.forename: Michelle B
authors.initials: MB
authors.lastname: Vanstone
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Oberfield
authors.forename: Laurel
authors.initials: L
authors.lastname: Shader
authors.forename: Laleh
authors.initials: L
authors.lastname: Ardeshirpour
authors.forename: Thomas O
authors.initials: TO
authors.lastname: Carpenter
mesh_terms: D000328:Adult; D002118:Calcium / Q000097:blood*; D002648:Child; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000139:chemically induced*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D014807:Vitamin D / Q000008:administration & dosage / Q000009:adverse effects*; D014808:Vitamin D Deficiency / Q000097:blood / Q000188:drug therapy*; D014815:Vitamins / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D014815:Vitamins; D014807:Vitamin D; D002118:Calcium