Vitamin D

1. PREVENTION OF NUTRITIONAL
RICKETS
VITAMIN D SUPPLEMENTATION
-For infants and preterm babies :400IU VtD / day
-Routinely for high risk conditions -children receiving long term
glucocorticoids , ketoconazole, CKD,chronic liver disease , malabsorption
states, hyperparathyroidisms,nonambulatory states,
cutaneous disorders
-routine screening for high risk people
-Calcium supplements for pregnant and lactating mothers :1200mg daily ,1.5
to 2 g for pre eclampsia patients

2. Sunlight
-recommended exposure : atleast 5 times a week during noon
11AM -3PM for children and adolescents across all regions of India to
increase 25(0H)D levels
-17 to 30 mins exposure for infants
-over 15-40% of body surface area
-sunscreens shouldn’t be routinely used for children as they decreases
serum VtD levels

3. DIET
-Vtd rich foods - fish oils , liver , egg yolk , fortified foods , milk
-adequate calcium intake - 500mg/day :infancy
600mg/day:1 to 9 yrs
800mg/day : adolescents
HYPERVITAMINOSIS D
Cause :Administration of VtD in therapeutic doses for long
periods. If VtD > 1000IU/day for infants
>2000IU/day for adults

4. CLINICAL FEATURES
-polyuria ,nephrocalcinosis,nephrolithiasis,renal failure (renal manifestation)
-anorexia,abdominal pain, constipation(GIT)
-Hypotonia, irritability, disorientation, covulsions, coma
-cardiac arrhythmias leading to death or electrolyte abnormalities secondary to
dehydration
DIAGNOSIS
Confirmed by high calcium in serum:>11.3mg/dl (birth to 3 months)
>11.2mg/dl(3 -6months), >11.3mg/dl(6 -12 months),>11.1mg/dl(1-3 yrs),
>10.7mg/dl (4 -18yrs)
-hypercalciuria (>4mg/kg/day) ,25(OH)VtD>100ng/ml, decreased serum
PTH,calcium : creatinine <0.2 (age>2yrs)

5. TREATMENT
Elimination of excess VtD and management of dehydration , electrolyte
abnormalities
-give oral prednisolone , calcitonin , bisphonates .