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Vitamin D status in children: From deficiency to toxicity

Shiyam Sunder Tikmani

Vitamin D is a hormone that regulates calcium metabolism. Children less than five years require 400 to 600 IU of vitamin D per day. The deficiency of vitamin D is a problem throughout world especially in Pakistan where the prevalence of vitamin D deficiency was 41.1% according to National Nutrition Survey of Pakistan in 2011.[1] In Pakistan intramuscular injections of vitamin D3 are being given to manage vitamin D deficient status. Injection vitamin D3 is available in 600000 IU (15 mg). Vitamin D toxicity has been attributed to a variety of factors including over-the-counter vitamin D supplements and dosing errors.[2] It is very difficult to recognize signs of vitamin D toxicity because clinical signs are nonspecific and children may brought to hospitals with severe dehydration, fatigue, muscle weakness, constipation and metastatic calcification It is imperative that careful history about over –the- counter supplementation, doses and frequency should be taken from parents in order to diagnosis and initiate treatment. In case series from America and India in 2012 and 2013 respectively, it was reported that children treated for vitamin D deficiency showed toxicity. The treatment of vitamin D toxicity includes restriction of vitamin D and calcium intake.[2, 3] We raise the consideration that with heightened awareness of vitamin D deficiency and increased prescribing of pharmacologic vitamin D to children under five years of age, an increased risk of toxicity is also emerging. Recommendations for vitamin D therapy require reexamination for safety in this age group. Also efforts should be made to educate doctors, not to irrationally prescribe vitamin D.

References:

1.	Bhutta ZA: National Nutrition Survey Pakistan. In.; 2011.

2.	Rajakumar K, Reis EC, Holick MF: Dosing Error With Over-the-Counter Vitamin D Supplement A Risk for Vitamin D Toxicity in Infants. Clinical Pediatrics 2013, 52(1):82-85.

3.	Vanstone MB, Oberfield SE, Shader L, Ardeshirpour L, Carpenter TO: Hypercalcemia in children receiving pharmacologic doses of vitamin D. Pediatrics 2012, 129(4):e1060-e1063.