Tzu-Hua Lin1, Hsiang-Ju Lu2,3, Chao-Hsu Lin2,4, Ming-Dar Lee2, Brian Pin-Hsuan Chang1,5,6,7, Chun-Chen Lin1,5,6, Jeng-Daw Tsai8,9,10,11. 1. Department of Pediatrics, MacKay Children's Hospital, No 92, Section 2, Chung-Shan North Road, Taipei, Taiwan. 2. Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan. 3. Department of Pediatrics, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan. 4. Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan. 5. Department of Medicine, Mackay Medical College, New Taipei City, Taiwan. 6. Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan. 7. Graduate Institute of Health and Biotechnology Law, Taipei Medical University, Taipei, Taiwan. 8. Department of Pediatrics, MacKay Children's Hospital, No 92, Section 2, Chung-Shan North Road, Taipei, Taiwan. tsaijd@yahoo.com.tw. 9. Department of Medicine, Mackay Medical College, New Taipei City, Taiwan. tsaijd@yahoo.com.tw. 10. Department of Pediatrics, Taipei Medical University, Taipei, Taiwan. tsaijd@yahoo.com.tw. 11. Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. tsaijd@yahoo.com.tw.
Abstract
BACKGROUND: Vitamin D supplements are readily available as over-the-counter preparations. However, although rare, cases of vitamin D overdose still occur and are associated with nephrocalcinosis and life-threatening hypercalcemia. Errors in manufacturing of nutritional supplements may be a cause of vitamin D intoxication in children. This study aimed to identify factors associated with vitamin D overdose-related nephrocalcinosis in children due to manufacturing errors in supplements. METHODS: This retrospective study reviewed medical charts of pediatric patients with non-registered supplement-related vitamin D overdose at a tertiary referral hospital between 2006 and 2011. Clinical and laboratory characteristics of patients with or without nephrocalcinosis were evaluated. Receiver operating characteristics curve and area under the receiver operating characteristics curve were used to determine the most predictive value of each characteristic. RESULTS: A total of 44 patients (males: 29; age: 7-62 months) were included. Age ≤ 16.5 months, body weight ≤ 10.25 kg, body height ≤ 78.5 cm, body surface area (BSA) ≤ 0.475 m2, 25-hydroxyvitamin D3 ≥ 143 ng/mL, and calcium ≥ 10.65 mg/dL were predictive of developing nephrocalcinosis with a sensitivity and specificity of > 60%. Univariant analysis revealed that BSA was the most significant anthropometric prognostic factor (odds ratio: 12.09; 95% confidence interval: 2.61-55.72; P = 0.001). CONCLUSIONS: Children with smaller BSAs were more vulnerable to high-dose vitamin D3-related nephrocalcinosis. Physicians and parents should be aware of the potential adverse effects of vitamin D overdose in children. A higher resolution version of the Graphical abstract is available as Supplementary information.
BACKGROUND: Vitamin D supplements are readily available as over-the-counter preparations. However, although rare, cases of vitamin D overdose still occur and are associated with nephrocalcinosis and life-threatening hypercalcemia. Errors in manufacturing of nutritional supplements may be a cause of vitamin D intoxication in children. This study aimed to identify factors associated with vitamin D overdose-related nephrocalcinosis in children due to manufacturing errors in supplements. METHODS: This retrospective study reviewed medical charts of pediatric patients with non-registered supplement-related vitamin D overdose at a tertiary referral hospital between 2006 and 2011. Clinical and laboratory characteristics of patients with or without nephrocalcinosis were evaluated. Receiver operating characteristics curve and area under the receiver operating characteristics curve were used to determine the most predictive value of each characteristic. RESULTS: A total of 44 patients (males: 29; age: 7-62 months) were included. Age ≤ 16.5 months, body weight ≤ 10.25 kg, body height ≤ 78.5 cm, body surface area (BSA) ≤ 0.475 m2, 25-hydroxyvitamin D3 ≥ 143 ng/mL, and calcium ≥ 10.65 mg/dL were predictive of developing nephrocalcinosis with a sensitivity and specificity of > 60%. Univariant analysis revealed that BSA was the most significant anthropometric prognostic factor (odds ratio: 12.09; 95% confidence interval: 2.61-55.72; P = 0.001). CONCLUSIONS: Children with smaller BSAs were more vulnerable to high-dose vitamin D3-related nephrocalcinosis. Physicians and parents should be aware of the potential adverse effects of vitamin D overdose in children. A higher resolution version of the Graphical abstract is available as Supplementary information.
Authors: A Catharine Ross; Joann E Manson; Steven A Abrams; John F Aloia; Patsy M Brannon; Steven K Clinton; Ramon A Durazo-Arvizu; J Christopher Gallagher; Richard L Gallo; Glenville Jones; Christopher S Kovacs; Susan T Mayne; Clifford J Rosen; Sue A Shapses Journal: J Am Diet Assoc Date: 2011-04