Comparison of Treatment Regimens in Management of Severe Hypercalcemia Due to Vitamin D Intoxication in Children

Abstract

Objective: No large study has been conducted to date to compare the effectiveness of prednisolone, alendronate and pamidronate as first-line treatment in children with hypercalcemia due to vitamin D intoxication. The aim was to perform a multicenter, retrospective study assessing clinical characteristics and treatment results. Methods: A standard questionnaire was uploaded to an online national database system to collect data on children with hypercalcemia (serum calcium level >10.5 mg/dL) due to vitamin D intoxication [serum 25-hydroxyvitamin D (25(OH)D) level >150 ng/mL] who were treated in pediatric endocrinology clinics. Results: Seventy-four children [median (range) age 1.06 (0.65-1.60) years, 45 males (61%) from 11 centers] were included. High-dose vitamin D intake was evident in 77% of the cases. At diagnosis, serum calcium, phosphorus, alkaline phosphatase, 25(OH)D and parathyroid hormone concentrations were 15±3.2 mg/dL, 5.2±1.2 mg/dL, 268±132 IU/L, 322 (236-454) ng/mL, and 5.5 (3-10.5) pg/mL, respectively. Calcium levels showed moderate correlation with 25(OH)D levels (r s =0.402, p<0.001). Patients were designated into five groups according to the initial specific treatment regimens (hydration-only, prednisolone, alendronate, pamidronate, and combination). Need for another type of specific drug treatment was higher in children who initially received prednisolone (p<0.001). Recurrence rate of hypercalcemia was significantly lower in children who were treated with pamidronate (p=0.02). Conclusion: Prednisolone is less effective in the treatment of children with severe hypercalcaemia secondary to vitamin D intoxication and timely implementation of other treatment regimens should be considered.

Vitamin D Intoxication Presenting as Subacute Encephalopathy—A Case Report

“…Neurological manifestations like hypotonia, hyporeflexia, and encephalopathy as present in our case are less commonly reported. 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 Vitamin D intoxication may be incidentally detected due to hypercalcemia. 11 , 12 …”

“…Vitamin D intoxication was diagnosed based on history, clinical features suggestive of hypercalcemia, elevated levels of calcium in serum and urine, reduced levels of serum intact PTH and serum 25-hydroxy vitamin D level more than 150 ng/mL. 3 , 15 …”

Successful management with bisphosphonate treatment in a child with tuberculosis-associated hypercalcemia

“…Although systemic glucocorticoids are commonly used in the management of severe hypercalcemia, no steroids were administered to our patient because of unknown etiology of hypercalcemia at initial. Besides this, recent studies reveal that pamidronate-disodium is more effective than glucocorticoids in the treatment of children with severe hypercalcemia secondary to vitamin D intoxication or increased vitamin D effects [ 11 , 12 ]. Therefore, pamidronate-disodium can be an effective alternative to glucocorticoids to treat severe hypercalcemia in patients with a suspicion of tuberculosis.…”

Severe hypercalcaemia secondary to vitamin D intoxication in a 2-year-old boy – a case report

“…Na ogół przedawkowanie witaminy D definiuje się jako stan, w którym stężenie 25(OH)D w surowicy pacjenta wynosi 100-150 ng/ml (7) . Niektórzy autorzy przyjmują nawet wartości niższe, powyżej 80 ng/ml (8) .…”

“…W zależności od stężenia wapnia (Ca) i jonów wapniowych (Ca 2+ ) w surowicy krwi wyróżnia się hiperkalcemię łagodną (Ca <3 mmol/l, Ca 2+ <2 mmol/l), umiarkowaną (Ca 3-3,5 mmol/l, Ca 2+ 2-2,5 mmol/l) i ciężką (Ca >3,5 mmol/l, Ca 2+ >2,5 mmol/l) (6) . Przedawkowanie 25(OH)D wymaga odstawienia preparatów zawierających witaminę D. W zależności od stężenia wapnia i stanu klinicznego pacjenta stosuje się również diurezę forsowaną, podaż jonów fosforanowych, glikokortykosteroidy, fenobarbital, kalcytoninę oraz bisfosfoniany (7,(9)(10)(11). Przy ciężkiej, zagrażającej życiu hiperkalcemii (>5 mmol/l) można rozważyć hemodializę (9) .…”