Vitamin D supplementation and risk of toxicity in pediatrics: a review of current literature.
Level 5 - mechanism / opinion, no new human data
Narrative review of pediatric clinical trials and case reports
PubMed 24456284 · doi:10.1210/jc.2013-3655
What was done
The authors searched PubMed through May 2013 for pediatric trials and case reports of vitamin D intoxication to assess safety data and formulate clinical recommendations on behalf of the Pediatric Endocrine Society Drugs and Therapeutics Committee.
What was found
A small number of pediatric trials evaluated doses at or above the upper tolerable intake level. In children and adolescents, vitamin D excess was rare and usually asymptomatic. Reported cases of intoxication resulted from manufacturing, formulation, or prescription errors involving total intakes of 240,000 to 4,500,000 IU, presenting with severe hypercalcemia, hypercalciuria, or nephrocalcinosis. In infants with rickets, mild hypercalcemia and hypervitaminosis occurred at currently recommended doses. The abstract provides no exact quantitative counts of total cases or studies reviewed.
Why it matters
It demonstrates that severe pediatric vitamin D toxicity is primarily driven by massive dosage or manufacturing errors, but highlights the need for biochemical monitoring in infants receiving high-range doses or treated for rickets.
Limits
The review relies on a small number of pediatric studies and case reports without systematic review methodology, meta-analytic pooling, or risk of bias assessment reported in the abstract. Total study and subject counts are not specified.
Cited by
- partial Some over-the-counter vitamin D3 and melatonin supplements have been found to contain 1,000 to 10,000 times more active ingredient than stated on the label.