Bothra Meenakshi, Gupta Nandita, Jain Vandana
J Pediatr Endocrinol Metab. 2016 Jun 1;29(6):687-92. doi: 10.1515/jpem-2015-0031.
The treatment practices for vitamin D deficiency rickets are highly variable. Though a single intramuscular (IM) megadose of vitamin D is economical, and ensures good compliance, it poses the risk of hypervitaminosis D. This observational study was conducted to assess the duration of effect and safety of single IM megadose of cholecalciferol in the treatment of vitamin D deficiency rickets.
Children younger than 14 years with rickets were enrolled. Baseline investigations included radiograph of wrists and estimation of serum calcium, phosphate, alkaline phosphatase (ALP), 25(OH) vitamin D and parathormone (PTH) levels. All children received a single IM megadose of vitamin D3. Biochemical parameters were re-evaluated at 1.5, 3 and 6 months after the megadose and the values were compared to the baseline.
We enrolled 21 children, out of which nine remained under active follow-up till 6 months. Radiological evidence of rickets was present in all 21 children, 14 had hypocalcemia at the time of presentation. After IM cholecalciferol megadose, median 25 hydroxy vitamin D [25(OH)D] level remained significantly more than the baseline till 6 months after the megadose. At 1.5 months after the vitamin D megadose, three (30%) of the children were found to develop toxic levels of vitamin D (>150 ng/mL), although none had hypercalcemia or any clinical manifestation of vitamin D toxicity. At 3 months and 6 months after the megadose, 25(OH)D levels remained in the sufficient range (20-100 ng/mL) in seven out of the eight children who came for follow-up.
A single IM megadose of vitamin D may be effective in significantly increasing the 25(OH)D levels for at least 6 months in children with rickets, but elevation of 25(OH)D to toxic range raises concern regarding its safety.
维生素D缺乏性佝偻病的治疗方法差异很大。尽管单次肌内注射大剂量维生素D经济实惠且能确保良好的依从性，但存在维生素D过量的风险。本观察性研究旨在评估单次肌内注射大剂量胆钙化醇治疗维生素D缺乏性佝偻病的疗效持续时间和安全性。
纳入14岁以下的佝偻病患儿。基线检查包括手腕X线片以及血清钙、磷、碱性磷酸酶（ALP）、25（OH）维生素D和甲状旁腺激素（PTH）水平的测定。所有患儿均接受单次肌内注射大剂量维生素D3。在注射大剂量维生素D后1.5、3和6个月重新评估生化指标，并将结果与基线值进行比较。
我们纳入了21名儿童，其中9名在6个月时仍处于积极随访中。所有21名儿童均有佝偻病的影像学证据，14名在就诊时存在低钙血症。肌内注射大剂量胆钙化醇后，25羟维生素D [25（OH）D]水平的中位数在注射大剂量后6个月内仍显著高于基线水平。在维生素D大剂量注射后1.5个月，发现3名（30%）儿童维生素D水平达到中毒水平（>150 ng/mL），尽管没有患儿出现高钙血症或任何维生素D中毒的临床表现。在大剂量注射后3个月和6个月，前来随访的8名儿童中有7名的25（OH）D水平保持在充足范围内（20 - 100 ng/mL）。
单次肌内注射大剂量维生素D可能有效显著提高佝偻病患儿的25（OH）D水平至少6个月，但25（OH）D升高至中毒范围引发了对其安全性的担忧。
