Vitamin D supplementation and risk of toxicity in pediatrics: a review of current literature.
BACKGROUND
Although vitamin D toxicity is rare in children, increased use of vitamin D formulations, re-examination of optimal vitamin D levels, and use of higher doses lend potential for an increased incidence of vitamin D toxicity.


METHODS
A PubMed search was conducted through May 2013 for cases of vitamin D intoxication and vitamin D trials in pediatrics. Safety data were collected and reviewed.


RESULTS
A small number of pediatric studies tested vitamin D doses at or above the currently recommended upper tolerable intake. In children and adolescents, vitamin D excess was rare and usually asymptomatic. Recent cases of intoxication relate to errors in manufacturing, formulation, or prescription; involve high total intake in the range of 240,000 to 4,500,000 IU; and present with severe hypercalcemia, hypercalciuria, or nephrocalcinosis. However, mild hypercalcemia and hypervitaminosis using currently recommended doses have been reported in infants with rickets.


CONCLUSIONS
Although rare, cases of vitamin D intoxication that present with dramatic life-threatening symptoms still occur in children. Moreover, recent studies in infants raise a potential need for monitoring vitamin D levels when doses at or above the currently recommended upper range are used. Further studies are needed to clarify these findings. The Drugs and Therapeutics Committee of the Pediatric Endocrine Society suggests obtaining serum 25-hydroxyvitamin D levels in infants and children who receive long-term vitamin D supplementation at or above the upper level intake that is currently recommended.
Weill Cornell Medical College (M.G.V.), New York, New York 10065; SUNY Downstate Medical Center (E.J.-D.), Brooklyn, New York 11203; and University of Virginia Health System (M.D.D.), Charlottesville, Virginia 22908.
Maria G
MG
Vogiatzi
Elka
E
Jacobson-Dickman
Mark D
MD
DeBoer
D000293:Adolescent; D000367:Age Factors; D002648:Child; D019587:Dietary Supplements / Q000009:adverse effects*; D006801:Humans; D006934:Hypercalcemia / Q000139:chemically induced; D053565:Hypercalciuria / Q000139:chemically induced; D009397:Nephrocalcinosis / Q000139:chemically induced; D064167:Recommended Dietary Allowances; D012307:Risk Factors; D014807:Vitamin D / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D014808:Vitamin D Deficiency / Q000188:drug therapy* / Q000453:epidemiology
D014807:Vitamin D; C104450:25-hydroxyvitamin D