Recently, an accident occurred at a friend’s home:
A 3-year-old child, taking advantage of the adults’ inattention, swallowed an entire box of vitamin D capsules. The mischievous child only swallowed the liquid inside and spat the capsule shells on the floor.
When it was discovered, the elderly at home panicked and tried to induce vomiting by sticking fingers down the throat, but after a long struggle, nothing much came up; the family rushed to the hospital in a hurry, hoping the doctor would perform gastric lavage on the child.
However, the doctor said that vitamin D is a liquid and may have already entered the child’s intestines and been absorbed, and since the medication is not a deadly poison, gastric lavage is generally not recommended. Instead, blood tests and hospital observation are suggested.
The mother was a bit hesitant after hearing this and quickly asked me what to do. She was eager to know whether vitamin D poisoning could be life-threatening and how to treat it.
Upon receiving the mother’s message, I first inquired about the child’s current condition. The mother said that the child was crying and making a fuss due to the scare and the折腾 when they first arrived at the hospital, but now they have calmed down and are watching cartoons in her arms, seemingly not in any other discomfort.
I breathed a sigh of relief and comforted the mother that the child’s condition was stable, and there was no need to rush for blood tests or hospitalization. Instead, we should first calculate the dose of vitamin D the child had ingested before making a decision.
Hearing this, the mother also became a bit calmer and recalled that the box of vitamin D had been opened recently, and after subtracting the few pills that had been taken before, the child might have ingested about 20-25 capsules at once. So we calculated based on 25 capsules, and the total amount the child ingested was approximately 400IU (IU, International Units) x 25, that is:
!
10,000IU
Such a large dose, more than ten times the daily recommended intake for a 3-year-old child (600IU), will it cause poisoning? Let’s analyze in detail below.
How much vitamin D intake can cause poisoning?
Long-term excessive intake of vitamin D is very dangerous.
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The daily safe intake limit for 0-6 months old is 1000IU;
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For 6-12 months old, it is 1500IU;
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For 1-3 years old, it is 2500IU.
But for a single large dose intake, current scientific research has not yet determined exactly what dose will definitely cause poisoning. However, according to foreign literature reports and statistics of vitamin D poisoning cases, the intake is usually 200,000 IU or more .
In comparison, the baby mentioned earlier ingested a maximum of 10,000 IU, which is not enough to cause poisoning. Instead, the subsequent attempts to induce vomiting could cause stomach contents to enter the trachea, leading to choking and aspiration, which is very dangerous for infants and young children.
What are the symptoms of vitamin D poisoning?
Vitamin D itself is not toxic, but it enhances the absorption of calcium in the gastrointestinal tract and affects other hormones that cause the release of calcium from bones. Therefore, the consequences of vitamin D poisoning are mainly caused by hypercalcemia , and the severity of hypercalcemia symptoms mainly depends on the blood calcium level and duration.
Symptoms of acute hypercalcemia include confusion, polyuria, thirst, anorexia, nausea, vomiting, and muscle weakness, even arrhythmias, while long-term chronic hypercalcemia can lead to nephrocalcinosis and kidney stones.
What tests and treatments are needed
if a child accidentally ingests vitamin D?
Is there a way to confirm whether the child who ingested an excessive amount of vitamin D has safe levels of vitamin D and blood calcium in their body?
The answer is yes, we can assess by monitoring the child’s 25-hydroxyvitamin D and blood calcium levels .
However, if the child has ingested a not too high amount at once and has not shown any discomfort symptoms indicating hypercalcemia, blood tests are not very necessary.
Even if the child has asymptomatic or mildly symptomatic hypercalcemia [serum calcium <3.5mmol/L), treatment is generally not needed, as long as ensuring fluid intake to promote the excretion of calcium in the kidneys and avoiding high-calcium foods for a while will be sufficient .
If the dose ingested by the child is uncertain, or if symptoms that require vigilance do appear, then it is necessary to seek medical attention promptly and provide corresponding treatment. Generally, hospitalization for fluid resuscitation, use of drugs to counteract hypercalcemia, and monitoring of blood calcium concentration are required until it drops to a safe range.
If the child has no discomfort symptoms after ingestion,
what else should be noted?
Is it necessary to stop milk and avoid sunlight?
Vitamin D is a fat-soluble vitamin that can be stored in fatty tissues. Children who have ingested a routine supplement (600 units daily) for a short period, so it is necessary to stop supplementing vitamin D for a while . For example, the child mentioned earlier, who ingested 10,000 IU of vitamin D at once, should stop taking vitamin D for the next 2-3 weeks.
It is also important to note that during this period, it is necessary to appropriately restrict the intake of high-calcium foods to avoid exacerbating hypercalcemia, and it is recommended to control calcium intake to less than 1000mg/day.
However, even pure milk, which is rich in calcium, contains only about 120mg of calcium per 100mL (formula milk contains 50-60mg), and considering the limited food intake of infants and young children, they usually will not exacerbate hypercalcemia by ingesting excessive dairy products.
In addition to dietary supplements, another way to obtain vitamin D is sun exposure on the skin , which converts 7-dehydrocholesterol in the skin into vitamin D3.
Since sunlight can also inactivate excess vitamin D3 into inactive metabolites, long-term skin exposure to the sun will not cause or exacerbate vitamin D poisoning , and children can go out as usual.
How to prevent accidental ingestion of medication?
To prevent pediatric medication poisoning incidents, the following measures can be taken:
Disclaimer: This article has been reviewed by the Distinct Health medical information team. The purpose of the article is to provide general health information. For personal medical issues, please consult a doctor. For article reprints, please contact: medicine@distinctclinic.com.
