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Rare infant vitamin D toxicity – due to errors which resulted in more that 240,000 IU – Jan 2014

Vitamin D Supplementation and Risk of Toxicity in Pediatrics: A Review of Current Literature.

J Clin Endocrinol Metab. 2014 Jan 23:jc20133655.
Vogiatzi MG, Jacobson-Dickman E, Deboer MD; for the Drugs, and Therapeutics Committee of The Pediatric Endocrine Society.
Weill Cornell Medical College, NY;

Context: While 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.

Evidence Acquisition: Pubmed search through May 2013 for cases of vitamin D intoxication and vitamin D trials in pediatrics. Safety data were collected and reviewed.

Evidence Synthesis: 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 has 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.

PMID: 24456284

See also VitaminDWiki

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