Pizzini Carla, Ossato Andrea, Realdon Nicola, Tessari Roberto
Department of Pediatrics, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy.
Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy.
Front Pediatr. 2024 Nov 19;12:1485814. doi: 10.3389/fped.2024.1485814. eCollection 2024.
Vitamin D is a vital lipophilic vitamin that plays a pivotal role in calcium regulation, bone metabolism, and overall health. It is of the utmost importance to maintain appropriate serum levels of vitamin D from the moment of birth. The recommended daily intake for infants under the age of 12 months is 400 IU. In Europe, vitamin D is available in two forms: as a medicinal product and as a food supplement. The food supplement market is experiencing rapid growth, yet it is characterised by a lack of harmonised regulations, which may give rise to potential risks associated with their widespread use. While food supplements are typically regarded as safe, there is a potential for adverse effects, particularly when dosages are not properly managed.
This report presents the case of a 22-month-old girl who developed nephrocalcinosis as a result of an overdose of vitamin D from a dietary supplement purchased online. The initial presentation was characterised by symptoms such as polydipsia, polyuria and decreased growth. It was subsequently revealed that the child had been receiving an excessively high dose of vitamin D, amounting to 25 times the recommended amount, over a period of seven months. Despite normal calcium levels and renal function at the time of presentation, ultrasound imaging revealed the presence of early-stage nephrocalcinosis. The treatment plan involved hospital admission, intravenous hydration, a thiazide diuretic, potassium citrate, and a low-calcium diet. The vitamin D supplement was ceased. Over the course of a year, the patient demonstrated recovery in growth and normalization of vitamin D levels, although nephrocalcinosis remained stable.
This case study highlights the potential dangers of unsupervised vitamin D supplementation, emphasising the importance of healthcare professionals exercising vigilance in prescribing and advising on vitamin D use, particularly in children. Furthermore, it underscores the necessity of establishing a database to track long-term outcomes in paediatric vitamin D intoxication cases, given the rarity of such incidents. This would facilitate the development of appropriate treatment protocols and provide valuable information to parents.
维生素D是一种重要的脂溶性维生素，在钙调节、骨代谢和整体健康中起着关键作用。从出生起就维持适当的血清维生素D水平至关重要。12个月以下婴儿的推荐每日摄入量为400国际单位。在欧洲，维生素D有两种形式：作为药品和作为食品补充剂。食品补充剂市场正在迅速增长，但其特点是缺乏统一的法规，这可能会带来与广泛使用相关的潜在风险。虽然食品补充剂通常被认为是安全的，但存在不良反应的可能性，尤其是在剂量管理不当的情况下。
本报告介绍了一名22个月大女孩的病例，她因过量服用从网上购买的膳食补充剂中的维生素D而患上肾钙质沉着症。最初的表现为多饮、多尿和生长发育迟缓等症状。随后发现，该儿童在七个月的时间里一直接受过量的维生素D，剂量高达推荐量的25倍。尽管就诊时血钙水平和肾功能正常，但超声检查显示存在早期肾钙质沉着症。治疗方案包括住院、静脉补液、噻嗪类利尿剂、枸橼酸钾和低钙饮食。停用了维生素D补充剂。在一年的时间里，患者的生长发育有所恢复，维生素D水平恢复正常，尽管肾钙质沉着症仍保持稳定。
本病例研究突出了无监督维生素D补充的潜在危险，强调了医疗保健专业人员在开具维生素D处方和提供使用建议时保持警惕的重要性，特别是在儿童中。此外，鉴于此类事件的罕见性，强调了建立一个数据库以跟踪儿科维生素D中毒病例长期结果的必要性。这将有助于制定适当的治疗方案，并为家长提供有价值的信息。
