Table 3.

Case reports of VDT in pediatrics.

Information about the Patients (Age in Months)	Results of Examination	Toxicity Management	Refs.
A total of 15 pediatric patients aged 24–60 months (mean age 46.53  ±  10.14 months) with a history of ingestion of more than 1500 IU/day of vitamin D supplements	The mean ingested dose was 8.13  ±  4.54 soft gelatin capsules or 406,700.7  ±  227,400.1 IU vitamin D. One patient had ingested 500,000 IU vitamin D with serum Ca level of 12.5 mg/dL. Eight (53.3%) cases had 25(OH)D levels > 100 ng/mL. The mean serum 25(OH)D levels of the patients was higher than normal: 111.3  ±  113.6 ng/mL (normal 30–100 ng/mL). There was no significant difference between variables in patients with and without a high level of 25(OH)D.	There were 8 patients (53.3%) who were hospitalized and treated with activated charcoal and fluid therapy, discontinued consumption of vitamin D supplements, kept low-calcium and vitamin D diet, took more liquid for at least one month, and were monitored for 25(OH)D levels.	[84]
Two infants with an identical presentation. One was a 3.5-month-old Caucasian female and the other a 2.5-month-old Caucasian male. The patients were exclusively breastfed and had received OTC vitamin D supplementation higher than the recommended dose. The female infant was given vitamin D3 2000 IU/day for 2.5 months, while the male infant was given vitamin D3 20,000 IU/day for 1.5 weeks	Physical examination of both patients showed evidence of moderate dehydration. Laboratory analysis of the female infant: Serum Ca: 21 mg/dL (normal 8.8–11.2 mg/dL) 25(OH)D: 644 ng/mL (normal 30–100 ng/mL) PTH: <1 pg/mL (normal 14–72 pg/mL) Laboratory analysis of the male infant: Serum Ca: 15 mg/dL (normal 8.5–10.1 mg/dL) 25(OH)D: 680 ng/mL (normal 30–100 ng/mL) 1,25(OH)2D: 166 pg/mL (normal 15–75 pg/mL) PTH: <7 pg/mL (normal 15–65 pg/mL)	The infants received IV hydration with normal saline and dextrose-containing solution at the PICU where they received furosemide 1 mg/kg/dose every 8 h and prednisone 1 mg/kg/day. The male infant received calcitonin 4 IU/kg × 1 dose. They both exhibited improvement of hypercalcemia after 2 to 3 days of treatment. On discharge, the serum Ca of the female infant was 11 mg/dL and the male infant was 10.8 mg/dL; both were clinically improved.	[85]
A 3-month-old Asian–American male infant who had been exclusively breastfed. The oral vitamin D supplementation was started on day 5 (400 IU/day), but the parents had made a mistake when administering a new brand of infant vitamin D liquid preparation to a 30-fold overdose of vitamin D (12,000 IU) daily for 20 days	The infant had no history of irritability, constipation, or abnormal movements. Laboratory analysis: Serum Ca: 10.5 mg/dL (normal 8.5–10.1 mg/dL) Phosphorus: 6.4 mg/dL (normal 4.5–6.5 mg/dL) Electrolyte panel, creatinine, and blood urea nitrogen were normal. Serum 25(OH)D: 422 ng/mL (normal 30–100 ng/mL) Serum 1,25(OH)2D: 61 pg/mL (normal 27–71 pg/mL) PTH: <3 pg/mL (normal 15–65 pg/mL)	The parents were asked to stop giving vitamin D to the infants.	[86]
A 3-month-old male infant with severe anorexia, vomiting, and weight loss. The infant was born at term, weighing 2.3 kg, and had been exclusively breastfed with no medical problems. The infant was exposed to 40,000–50,000 IU of vitamin D supplement/day, which represents 50-fold the Upper tolerable Level (UL) recommended.	At the time of admission, the infant weighed 4.5 kg with no fever. HR 109 beats/minute, BP 107/85 mmHg, oxygen saturation 99%. Laboratory analysis: Serum Na: 139 mmol/L Serum K: 4.4 mmol/L Alkaline reserve: 21 mmol/L Hb: 9.1 g/dL Leukocytes: 11.11 g/L Platelets: 471 g/L C-reactive protein: 13 mg/L with a negative procalcitonin Serum Ca: 3.08 mmol/L (normal 2.15–2.55 mmol/L) Serum albumin: 41 g/L (normal 34–42 mg/L) PTH: <18 ng/L (normal 18–88 ng/L) Serum 25(OH)D: > 400 ng/mL (normal 30–400 ng/mL) Serum 1,25(OH)2D: 200 pg/mL (normal < 182 pg/mL) Phosphate: 1.8 mmol/L (normal 1.6–2.4 mmol/L) Serum creatinine: 23 μmol/L (normal 15–37 μmol/L) Urea: 2.3 mmol/L (normal 1.8–6.4 mmol/L) Blood gases analysis and liver function tests were within normal range.	The patient was hospitalized, given IV hydration, and examined for immunoglobulin E (IgE) antibodies to cow milk, cranial ultrasonography, brain magnetic resonance imaging, and abdominal ultrasound. Because of a suspicion of urinary infection, IV antibiotic therapy was also given for 3 days. The patient was discharged after 2 weeks with a weight of 4.8 kg and a close monitoring of his serum Ca.	[87]

BP: blood pressure; HR: heart rate; IV: intravenous; OTC: over the counter; PICU: pediatric intensive care unit; PTH: parathyroid hormone. All values are for infants.