Vitamin D toxicity in a pediatric toxicological referral center; a cross-sectional study from Iran

Abstract

Background Vitamin D is an essential element for body health with its supplements generally administered to prevent vitamin D deficiency. Since these supplements are available in domestic settings, vitamin D toxicity may happen in children. Methods All children younger than 12 years who presented to the pediatric emergency department of Loghman Hakim Hospital, Tehran, Iran with history of ingestion of more than 1500 IU/day of vitamin D supplements were enrolled. Patients’ demographic data, on-presentation signs and symptoms, laboratory findings, treatments given, and outcome were evaluated. Result Fifteen patients presented during the study period. Their mean age was 46.53 ± 10.14 months and 12 (80%) were girls. All of them had unintentionally ingested vitamin D. Mean ingested dose was 406700.7 ± 227400.1 IU. In eight patients (53.3%), 25 hydroxy vitamin D level was more than 100 ng/mL. One patient experienced hypercalcemia while all of them were asymptomatic and discharged without complications. There was no significant difference between patients with and without high levels of 25 OH vitamin D regarding lab tests, toxicity course, and outcome. Conclusions It seems that acute vitamin D toxicity is a benign condition in our pediatric population which may be due to high prevalence of vitamin D deficiency in Iran.

Hypervitaminosis D and nephrocalcinosis: too much of a good thing?

“…Lin et al show that younger age is associated with an increased risk of the development of nephrocalcinosis [30]. While Çağlar and Çağlar found no significant difference in age, all patients in their cohort were less than 4 years old [31], a trend which seems consistent with other published reports in children [8,33,34].…”

Vitamin D Intoxication in Three Children With Varied Manifestations: A Case Series and Review

“…Only one child had hypercalcemia, and eight had vitamin D levels more than 100 ng/mL. This study concluded that acute vitamin D toxicity might be a benign condition in Iranian children due to the high prevalence of vitamin D deficiency [13].…”

Clinical Toxicology of Vitamin D in Pediatrics: A Review and Case Reports

“…VDT can be caused by a high dose of vitamin D combined with calcium which will promote hypercalcemia [ 81 ]. The symptoms of hypercalcemia are neurological (confusion, irritability, restlessness, and apathy, and in severe cases, can cause psychosis, stupor, and coma); cardiovascular (hypertension, shortened QT interval which indicates arrythmia, elevated ST segment, bradyarrhythmia, and first-degree heart block), gastrointestinal (abdominal pain, nausea, ulcer, vomiting, polydipsia, anorexia, constipation, and pancreatitis), and kidney symptoms (hypercalciuria, acute kidney injury (AKI), polyuria, polydipsia, dehydration, and nephrocalcinosis) [ 82 , 83 ]. Weakness, anorexia, loss of skin turgor, weariness, bone aches and dry mucous membranes (due to dehydration), changes in mental status, stomach soreness without rebound, rigidity, or guarding may occur as non-specific symptoms [ 83 ].…”