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
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
Daily high dose of 1,000 to 4,000 IU
which is less than IoM upper limit of 4,000 IU
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.
See also VitaminDWiki
- Children in Intensive Care need Vitamin D loading dose of 10000 IU per kg (nearing a consensus) - Oct 2016
- Vitamin D deficiency in adolescents, with 300,000 IU loading dose – Nov 2014
- Normalize vitamin D safely within 1-2 weeks – June 2014
- Vitamin D supplementation protocols: loading, injection, etc – RCT June 2014
- 600,000 IU of vitamin D2 every 4 months for decades in East Germany – 1987 loading doses given to all infants for decades
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
Note: study on this page suggests 10,000 IU/kg
(Chart only goes up to 5,000 IU/kg)