The majority of Indians who complain of brittle or painful bones believe they may be Vitamin D deficient and self-medicate with over-the-counter medications rather than having their levels checked or seeing a doctor. The end outcome is hypervitaminosis, a hazardous condition brought on by a vitamin D overdose.
And it shows up as a strange buildup of calcium in your blood (hypercalcemia), which can cause stress and failure of the kidneys. One such patient, who presented with acute kidney failure, disorientation, confusion, and cardiac stress, was recalled by Dr. Rommel Tickoo, Director of Internal Medicine at Max Super Speciality Hospital in Saket, Delhi.
“We discovered that he had been consuming a lot of vitamin D pills during our examinations. He adds that he had to spend a lot of time flushing out the toxic load from his system while receiving intravenous fluids and medication, typically corticosteroids or bisphosphonates.
Many people are unaware that deficits are typically addressed by exposure to sunlight or fortified foods. When these straightforward techniques fail to have a noticeable impact, supplementation is necessary. Since your body controls the amount of vitamin D produced by sun exposure and even fortified foods don’t contain much of it, there is no risk from these, according to Dr. Tickoo.
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What is hypervitaminosis?
Sadly, “overdosing” on vitamin D pills is on the rise, according to a new article in the BMJ Case Reports journal. In addition to various vitamin, mineral, nutritional, and probiotic supplements, it detailed the case of a middle-aged man who had been taking high quantities of more than 20 over-the-counter supplements daily.
According to Vaman Khadilkar, past president of the Indian Society for Pediatric and Adolescent Endocrinology and convener for the 2017 Indian Academy of Paediatrics IAP vitamin D and calcium guideline, “Hypervitaminosis is a disorder induced by high ingestion or injections of vitamin D. A serum level of greater than 100 ng/ml is regarded as hazardous.
It has been proven that toxicity can result from consuming 60,000 international units (IU) of vitamin D per day for several months. The US Recommended Dietary Allowance (RDA) for most adults is 600 IU of vitamin D per day, which is many times lower than this quantity. According to Dr. Tickoo, “some daring folks just keep swallowing medicines without any moderation.”
Sometimes, doses above the RDA are used to address medical conditions like vitamin D deficiency, but only when a doctor is present and for a predetermined amount of time. In order to prevent any potential complications, blood levels should be checked when someone is taking large dosages of vitamin D. “Hypervitaminosis has no significant warning symptoms. You ultimately visit the hospital for a diagnosis, claims Dr. Khadilkar.
Hypervitaminosis signs and symptoms
Drowsiness, confusion, apathy, psychosis, depression, stupor, and coma are examples of neuropsychiatric symptoms. “Other symptoms may include pancreatitis, nausea, vomiting, and generalized disorientation. Arrhythmias and hypertension are symptoms of vitamin D toxicity. Following that, there is polyuria, polydipsia, dehydration, kidney calcification, and renal failure, according to Dr. Tickoo.
According to Dr. Khadilkar, vitamin D poisoning in children “presents as excessive levels of calcium in the blood, vomiting, irritability, and dehydration.” Not all patients with high vitamin D serum levels (> 100 ng/ml) may experience symptoms, though.
What is the recommended daily intake of vitamin D?
400 international units (IU) of vitamin D per day are advised for infants up to 12 months old, 600 IU for those between the ages of 1 and 70, and 800 IU for those over 70. A fat-soluble vitamin called vitamin D is necessary for the body to function properly. Experts say it is crucial for the development of cells, the immune system, and muscles.
The guidelines on “How to treat Vitamin D deficiency in sun-drenched India” were written by C. V. Harinarayan from the Institute of Endocrinology, Diabetes, Thyroid and Osteoporosis Disorders in Bengaluru. They were published in the “Journal of Clinical and Scientific Research” of the Sri Venkateshwara Institute of Medical Sciences.
The main circulating form of vitamin D used to determine a person’s level of vitamin D is serum 25-hydroxyvitamin D (25(OH)D) levels. According to experts, levels between 20 and 30 ng/mL are considered inadequate. According to IAP-2021 recommendations, 400 IU/day of vitamin D supplementation is advised for infants.
However, older children and teenagers’ estimated average needs (400–600 IU/day, respectively) should be satisfied through nutrition and naturally occurring sources like sunlight. Healthcare professionals should be informed of the several vitamin D preparations that are offered in India and should inform patients about the best dosages and formulation variations.
Universal Vitamin D is not advised for certain conditions
According to the revised IAP Vitamin D guidelines, 2021, universal vitamin D supplementation is not recommended in the treatment of childhood pneumonia, diarrhea, tuberculosis, or HIV. This recommendation also applies to non-infectious conditions such as asthma, atopic dermatitis, and developmental disorders.
In children who have illnesses that put them at high risk for vitamin insufficiency, such as nephrotic syndrome, chronic liver disease, chronic renal failure, and other similar disorders, the serum level of 25-hydroxyvitamin D should be kept at >20ng/mL at all times.
How much sun is needed?
Intake of vitamin D and calcium are both essential for achieving and maintaining optimum bone health. Exposure to sunlight raises serum levels of 25(OH)D and is suggested for children and adolescents in all parts of India in order to prevent vitamin D insufficiency.
According to the recommendations provided by the IAP, infants should be exposed to sunlight for 17–30 minutes per day, while older children should receive 30–45 minutes of daily sunlight exposure over 15–40 percent of their body surface area. This exposure should take place at least five times per week during the middle of the day and in the afternoon (between the hours of 11 am and 3 pm).
Why is vitamin D important?
You need to take vitamin D supplements for a variety of reasons, one of which is to reduce the risk of developing metastatic cancer. Other benefits include improved bone health. “The use of vitamin D helps to ensure that our immune system is working properly.
It strengthens our resistance to certain diseases and contributes to the development of healthy bones and teeth. According to Dr. Tickoo, not only does it protect against respiratory infections, heart disease, and stroke, but it also reduces the risk of developing diabetes and protects against cognitive decline and dementia. “To achieve the best possible outcomes, it is recommended that you take a supplement that contains both vitamin D and vitamin K.
Both are lipid-soluble vitamins that complement one another in their ability to restore calcium levels in the body. “What I’m trying to say is that vitamin D speeds up the development of specific proteins, which in turn require vitamin K to perform at their optimal level,” he says.
In addition to this, Dr. Tickoo recommends taking vitamin D syrups because they are more easily absorbed by the body. Since vitamin D is a fat-soluble vitamin and since syrups already include fat, consuming syrups is a more effective way to boost the body’s absorption of the vitamin.
You should take it once every week for eight to twelve weeks, and then you should take it once every month after that,” he says. Before beginning to take vitamin D supplements, you should always consult with your primary care physician.
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