|LETTER TO EDITOR
|Year : 2017 | Volume
| Issue : 1 | Page : 59
Comment on: Supplementing vitamin D: Dangers of too much of a good thing: Reply
Saba Fathima1, Kurian Thomas1, Vineeta Shobha2, Jyothi Idiculla1
1 Department of Medicine, St. John's Medical College, Bengaluru, Karnataka, India
2 Department of Immunology, St. John's Medical College, Bengaluru, Karnataka, India
|Date of Web Publication||23-Feb-2017|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Fathima S, Thomas K, Shobha V, Idiculla J. Comment on: Supplementing vitamin D: Dangers of too much of a good thing: Reply. Indian J Rheumatol 2017;12:59
We thank Dr. Subramanian for his interest  in our case report on Vitamin D toxicity. This was to alert clinicians about the excessive and indiscriminate use of Vitamin D. The patient in the case report underwent a through screen to rule out malignancies of thyroid, breast, uterus, and intestines, which were all negative. On follow-up, she remains normocalcemic and well. If the biochemical parameters derange in future, we shall perform parathyroid hormone-related peptide assay as suggested by you.
The assay method used in our institution for Vitamin D estimation is chemiluminescent immunoassay. We have also observed low levels of Vitamin D even in asymptomatic individuals. The reason for this remains elusive, though studies on Vitamin D receptor polymorphisms and free Vitamin D levels may throw light.
Senior citizens are vulnerable to Vitamin D deficiency and consequent fractures. The Endocrine Society recommends Vitamin D levels above 30 ng/ml, while the Institute of Medicine's suggests levels above 20 ng/ml. The recommendation of the endocrine society is to provide at least 600 IU for those aged 50–70 and 800 IU in those above 70. A dose of 1500–2000 units a day is required to raise the levels to 30 ng/dl, which in turn will prevent fractures. In Indians, a daily dose of 2000 units is recommended. The dangers of over-treatment was reported by a case series from India recently. In order to correct deficiency 50,000 units/week for 8 weeks or equivalent daily doses is suggested. Parenteral administration may also be considered at the same dose as the effectiveness remains mostly similar.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Nallasivan S. Comment on: Supplementing Vitamin D: Dangers of Too Much of a Good Thing. Ind J Rheumatol 2017;12:58.
Fathima S, Tomas K, Shoba V, Idiculla J. Supplementing Vitamin D: Dangers of too much of a good thing. Indian J Rheumatol 2016;11:226-7.
Mudur G. Indian endocrinologists set guidance to combat Vitamin D deficiency. BMJ 2015;351:h5997.
Kaur P, Mishra SK, Mithal A. Vitamin D toxicity resulting from overzealous correction of Vitamin D deficiency. Clin Endocrinol (Oxf) 2015;83:327-31.
Zabihiyeganeh M, Jahed A, Nojomi M. Treatment of hypovitaminosis D with pharmacologic doses of cholecalciferol, oral vs. intramuscular; an open labeled RCT. Clin Endocrinol (Oxf) 2013;78:210-6.