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| LETTER TO EDITOR |
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| Year : 2017 | Volume
: 12
| Issue : 1 | Page : 59 |
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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 |
Correspondence Address:
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0973-3698.199134
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 |
Dear editor,
We thank Dr. Subramanian for his interest [1] in our case report on Vitamin D toxicity.[2] 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.[3] 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.[4] The dangers of over-treatment was reported by a case series from India recently.[5] In order to correct deficiency 50,000 units/week for 8 weeks or equivalent daily doses is suggested.[3] Parenteral administration may also be considered at the same dose as the effectiveness remains mostly similar.[6]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Nallasivan S. Comment on: Supplementing Vitamin D: Dangers of Too Much of a Good Thing. Ind J Rheumatol 2017;12:58.  |
| 2. | 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.  |
| 3. | |
| 4. | Mudur G. Indian endocrinologists set guidance to combat Vitamin D deficiency. BMJ 2015;351:h5997. |
| 5. | Kaur P, Mishra SK, Mithal A. Vitamin D toxicity resulting from overzealous correction of Vitamin D deficiency. Clin Endocrinol (Oxf) 2015;83:327-31. |
| 6. | 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. |
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