Weekly regimen of vitamin D supplementation is more efficacious than stoss regimen for treatment of vitamin D deficiency in children with chronic liver diseases
European Journal of Pediatrics. pp 1–8, Online: 04 March 2018, https://doi.org/10.1007/s00431-018-3123-0
Bikrant Bihari LalSeema Alam Rajeev Khanna, Dinesh Rawat
67 children aged 1-18 with Chronic Liver Disease and < 30 ng of vitamin D
25% of whom had rickets
|Rise at 12 weeks||Rise at 26 weeks||< 30 ng at 26 weeks|
|600,000 IU once|
twice if still < 30 ng at 26 weeks
|34 ng||30 ng||86%|
|60,000 IU weekly for 12 weeks|
but continue if still < 30 ng
|17 ng||11 ng||32%|
- Surprisingly they used same dose for babies as late teens (age: 1-18)
There is a general agreement that a Vitamin D dose should vary with weight
Just as there is a “baby aspirin” at 1/4 the dose there should be a “baby vitamin d”
- The study did, however, add Calcium in proportion to body weight
- “Oral calcium at a dose of 50 mg/kg/day”
- Surprisingly the same amount of Vitamin D was given independent of how deficient the child had been
What is Known:
- Vitamin D deficiency is more common and severe in children with chronic liver diseases.
- Currently used doses fail to achieve normal vitamin D levels in these children.
What is New?
- Weekly regimen of 60,000 IU of vitamin D3 is the most effective regimen for treating vitamin D deficiency in children with CLD.
- Children with CLD should further receive maintenance dose of 60,000 IU every month.
There are no evidence-based recommendations on the ideal dose and regimen for supplementation of vitamin D in children with chronic liver disease (CLD). This study aimed to compare the safety and efficacy of weekly and stoss regimens for treatment of vitamin D deficiency in these children.
Children between the ages of 1 to 18 years with CLD and hypovitaminosis D defined by 25-OH vitamin D (25(OH)D) < 30µg/l were included. They were randomized to receive either stoss regimen (600,000 IU on day 1) or weekly (60,000 IU weekly) regimen of vitamin D. The 25(OH)D levels at 3 and 6 months were compared in the two groups. A total of 210 suspected cases of CLD were assessed for eligibility. Of a total of 67 children satisfying the inclusion criteria, 33 and 34 were randomized to receive stoss and weekly regimen, respectively. Final analysis included 28 children in each group. Clinical rickets was seen in 25.4% of children with hypovitaminosis D. The rise in levels of 25(OH)D at 3 months was higher with weekly regimen (34.3 ± 30.7 µg/l) as compared to stoss regimen (17.2 ± 11.5 µg/l) (p = 0.009). Rise at 6 months as compared to baseline was significantly higher with weekly regimen (30.7 ± 24µg/l) as compared to stoss regimen (11 ± 8.4 µg/l) (p < 0.001). Normal levels of 25(OH)D at 6 months were achieved in 24/28 (85.7%) of those receiving weekly regimen and 9/28 (32.1%) of those receiving stoss regimen (p < 0.001). With stoss therapy, 25(OH)D increased at 3 months as compared to baseline but thereafter dropped significantly at 6 months (p = 0.008).
Conclusion: Weekly regimen of vitamin D supplementation is more effective than stoss regimen for treatment of hypovitaminosis D in children with CLD. Once normal levels are achieved, child should be shifted to 60,000 IU per month as maintenance dose.