Translation of a-t 2026; 57: 80

Vitamin D poisoning in infants - underappreciated risk of food supplements

The German Federal Institute for Risk Assessment (Bundesinstitut für Risikobewertung, BfR) is warning of potentially life-threatening vitamin D poisoning in infants. In July, the Institute received a report of an infant who was administered high-dose vitamin D in the form of a food supplement obtained on the internet. He experienced severe vitamin D poisoning.¹ Back in 2022, the Drug Commission of German Doctors (Arzneimittelkommission der deutschen Ärzteschaft, AkdÄ) published a report on a seven-month-old child who had to be treated in intensive care for weight loss, dehydration, reduced vigilance, pronounced electrolyte imbalance and nephrocalcinosis. After the infant initially received medically prescribed vitamin D prophylaxis of 500 IU daily, his parents had switched him on the advice of a friend to a high-dose food supplement they obtained via the internet, and gave him 40,000 IU daily for five months.²

In Germany, 400-500 IU of vitamin D3 daily is recommended in the child's first one to one and a half years or until the second early summer they experience in order to prevent rickets.^1,2 Approved medicines are available as tablets or drops for this indication and dose (VIGANTOL 500 IU and others).³ To this day, there is still no EU-wide maximum quantity determination for vitamins and minerals in food supplements and a corresponding national regulation.⁴ Highly concentrated food supplements containing vitamin D thus remain freely available. According to the BfR, several poisonings of children and adults linked to pronounced hypercalcaemia have been reported in Germany in the past few years (see a-t 2020; 51: 55-6). Insufficient drinking, vomiting, somnolence, muscle weakness, weight loss, failure to thrive, constipation, increased urine excretion and dehydration have been reported in infants, in addition to electrolyte imbalances with reduced sodium and increased calcium and potassium. If hypercalcaemia persists for a long time, calcification of the kidneys up to and including irreversible kidney failure can occur.¹

In our opinion, only the medicines approved for the indication should be used for rickets prevention in infants and young children. Food supplements, including those that are advertised as being suitable for children of all ages⁵ are not subject to any official (quality) testing. It is therefore not possible to rely on the quantities of active substance that are declared (a-t 2026; 57: 14). Poisoning with food supplements containing vitamin D at concentrations many times higher than those indicated has been described.⁶ Liquid preparations also bring with them the risk of an accidental overdose, for example by mixing up drops and millilitres as the dose measurement.⁷ BfR and AkdÄ advise avoiding highly concentrated liquid preparations.^1,2 We feel that providing good instruction for parents in medical practices and pharmacies is important. This also applies to the tablets that need to be fully dissolved in a small quantity of liquid before being used in infants and young children (a-t 2026; 57: 29-30), –Ed.

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