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Vitamin D loading doses of up to 400,000 IU OK for adolescents – meta-analysis Dec 2014

Rapid Normalization of Vitamin D Levels: A Meta-Analysis

Pediatrics Published online December 15, 2014, (doi: 10.1542/peds.2014-1703)
J. Dayre McNally, MD, PhDa,b, Klevis Iliriani, BSc (Hons)b,c, Supichaya Pojsupap, MDa,d, Margaret Sampson, MLIS, PHD, AHIPa, Katie O’Hearn, R Kin, MSca,b, Lauralyn McIntyre, MD, MSc, FRCPCe, Dean Fergusson, MHA, PhDf, and Kusum Menon, MD, MSca,b
A Department of Pediatrics, Faculty of Medicine, University of Ottawa, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada;
B Research Institute, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada;
C School of Medicine, Trinity College, Dublin, Ireland;
D Division of Critical Care, Department of Pediatrics, Phramonghutklao Hospital, Bangkok, Thailand; and
E Division of Critical Care, Department of Medicine, and
F Department of Epidemiology and Community Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada

VitaminDWiki Summary and comment

OK up to 300,000 IU / 10,000 IU/kg
Vitamin D level > 30 ng in less than 1 month
Hypercalcemia events > 400,000
   were probably due to too much Ca or too little Mg

All Studies

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Hypocalcemia

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Daily high dose of 1,000 to 4,000 IU
   which is less than IoM upper limit of 4,000 IU

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BACKGROUND: Vitamin D deficiency may represent a modifiable risk factor to improve outcome in severe illness. The efficacy of high-dose regimens in rapid normalization of vitamin D levels is uncertain.

METHODS: We conducted a systematic review of pediatric clinical trials administering high-dose vitamin D to evaluate 25-hydroxyvitamin D (25[OH]D) response and characteristics associated with final 25(OH)D levels by using Medline, Embase, and the Cochrane Central Register of Controlled Trials, including reference lists of systematic reviews and eligible publications. Uncontrolled and controlled trials reporting 25(OH)D levels after high-dose (≥1000 IU) ergocalciferol or cholecalciferol were selected. Two reviewers independently extracted and verified predefined data fields.

RESULTS: We identified 88 eligible full-text articles. Two of 6 studies that administered daily doses approximating the Institute of Medicine’s Tolerable Upper Intake Level (1000–4000 IU) to vitamin D–deficient populations achieved group 25(OH)D levels >75 nmol/L within 1 month.

Nine of 10 studies evaluating loading therapy (>50 000 IU) achieved group 25(OH)D levels >75 nmol/L. In meta-regression, baseline 25(OH)D, regimen type, dose, age, and time factors were associated with final 25(OH)D levels. Adverse event analysis identified increased hypercalcemia risk with doses >400 000 IU, but no increased hypercalcemia or hypercalciuria with loading doses <400 000 IU (or 10 000 IU/kg). Few studies in adolescents evaluated loading dose regimens >300 000 IU.

CONCLUSIONS: Rapid normalization of vitamin D levels is best achieved by using loading therapy that considers disease status, baseline 25(OH)D, and age (or weight). Loading doses >300 000 IU should be avoided until trials are conducted to better evaluate risk and benefit.

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See also VitaminDWiki

Overview Loading of vitamin D contains the following

If a person is, or is suspected to be, very vitamin D deficient a loading dose is typically given

  • Loading = repletion = quick replacement (previously known as Stoss)
  • Loading doses range in size from 100,000 IU to 1,000,000 IU of Vitamin D3
  • The size of the loading dose is a function of body weight - see below
    Unfortunately, some doctors persist in using Vitamin D2 instead of D3
  • Loading may be done as quickly as a single day, to as slowly as 3 months.
    It appears that spreading the loading dose over 4-20 days is a good compromise
  • Loading is typically oral, but sometimes by injection (I.M,)
  • The loading dose persists in the body for about 3 months
    The loading dose should be followed up with continuing maintenance
    Unfortunately, many doctors fail to follow-up with the maintenance dosing.
  • As about 1 in 300 people have some form of mild allergic reaction to vitamin D supplements,
    it appears prudent to test with a small amount of vitamin D before giving a loading dose
  • The causes of a mild allergic reaction appear to be: (in order of occurance)
    1) lack of magnesium - which can be easily added
    2) allergy to capsule contents - oil, additives (powder does not appear to cause any reaction)
    3) allergy to the tiny amount of D3 itself (allergy to wool) ( alternate: D3 made from plants )

has a chart showing the huge variation in response to a loading dose
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Note: study on this page suggests 10,000 IU/kg
(Chart only goes up to 5,000 IU/kg)

Created by admin. Last Modification: Sunday March 19, 2017 15:45:46 UTC by admin. (Version 12)

Attached files

ID Name Comment Uploaded Size Downloads
7861 Loading 1000 - 4000 daily.jpg admin 19 Mar, 2017 15:39 27.14 Kb 32
7860 High Dose F4.jpg admin 19 Mar, 2017 15:19 57.61 Kb 35
7859 High Dose T1.jpg admin 19 Mar, 2017 15:18 66.77 Kb 32
7858 Rapid Normalization of Vitamin D.pdf PDF 2014 admin 19 Mar, 2017 15:17 1.21 Mb 15
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