Vitamin D loading doses of up to 400,000 IU OK for adolescents – meta-analysis Dec 2014

Rapid Normalization of Vitamin D Levels: A Meta-Analysis

Pediatrics Published online December 15, 2014, (doi: 10.1542/peds.2014-1703)
J. Dayre McNally, MD, PhDa,b, Klevis Iliriani, BSc (Hons)b,c, Supichaya Pojsupap, MDa,d, Margaret Sampson, MLIS, PHD, AHIPa, Katie O’Hearn, R Kin, MSca,b, Lauralyn McIntyre, MD, MSc, FRCPCe, Dean Fergusson, MHA, PhDf, and Kusum Menon, MD, MSca,b
A Department of Pediatrics, Faculty of Medicine, University of Ottawa, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada;
B Research Institute, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada;
C School of Medicine, Trinity College, Dublin, Ireland;
D Division of Critical Care, Department of Pediatrics, Phramonghutklao Hospital, Bangkok, Thailand; and
E Division of Critical Care, Department of Medicine, and
F Department of Epidemiology and Community Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada

All Studies

Hypocalcemia

Daily high dose of 1,000 to 4,000 IU
   which is less than IoM upper limit of 4,000 IU

BACKGROUND: Vitamin D deficiency may represent a modifiable risk factor to improve outcome in severe illness. The efficacy of high-dose regimens in rapid normalization of vitamin D levels is uncertain.

METHODS: We conducted a systematic review of pediatric clinical trials administering high-dose vitamin D to evaluate 25-hydroxyvitamin D (25[OH]D) response and characteristics associated with final 25(OH)D levels by using Medline, Embase, and the Cochrane Central Register of Controlled Trials, including reference lists of systematic reviews and eligible publications. Uncontrolled and controlled trials reporting 25(OH)D levels after high-dose (≥1000 IU) ergocalciferol or cholecalciferol were selected. Two reviewers independently extracted and verified predefined data fields.

RESULTS: We identified 88 eligible full-text articles. Two of 6 studies that administered daily doses approximating the Institute of Medicine’s Tolerable Upper Intake Level (1000–4000 IU) to vitamin D–deficient populations achieved group 25(OH)D levels >75 nmol/L within 1 month.

Nine of 10 studies evaluating loading therapy (>50 000 IU) achieved group 25(OH)D levels >75 nmol/L. In meta-regression, baseline 25(OH)D, regimen type, dose, age, and time factors were associated with final 25(OH)D levels. Adverse event analysis identified increased hypercalcemia risk with doses >400 000 IU, but no increased hypercalcemia or hypercalciuria with loading doses <400 000 IU (or 10 000 IU/kg). Few studies in adolescents evaluated loading dose regimens >300 000 IU.

CONCLUSIONS: Rapid normalization of vitamin D levels is best achieved by using loading therapy that considers disease status, baseline 25(OH)D, and age (or weight). Loading doses >300 000 IU should be avoided until trials are conducted to better evaluate risk and benefit.

 Download the PDF from Vitamin D Life

See also Vitamin D Life

• Rapidly restore Vitamin D levels with 10,000 IU per kg for children in ICU – RCT 2024
• Children in Intensive Care need Vitamin D loading dose of 10000 IU per kg (nearing a consensus) - Oct 2016
• Vitamin D deficiency in adolescents, with 300,000 IU loading dose – Nov 2014
• Normalize vitamin D safely within 1-2 weeks – June 2014
• Vitamin D supplementation protocols: loading, injection, etc – RCT June 2014
• 600,000 IU of vitamin D2 every 4 months for decades in East Germany – 1987 loading doses given to all infants for decades

Overview Loading of vitamin D contains the following

Vitamin D loading dose (stoss therapy) proven to improve health overview
If a person is or is suspected to be, very vitamin D deficient a loading dose is typically given

• Loading = restore = quick replacement by 1 or more doses
• Loading doses range in total size from 100,000 IU to 1,000,000 IU of Vitamin D3
  • = 2.5 to 25 milligrams
• The size of the loading dose is a function of body weight - see below
  • Unfortunately, some doctors persist in using Vitamin D2 instead of D3
• Loading may be done as quickly as a single day (Stoss), to as slowly as 3 months.
  • It appears that spreading the loading dose over 4+ days is slightly better if speed is not essential
• Loading is typically oral, but can be Injection (I.M,) and Topical
• Loading dose is ~3X faster if done topically or swished inside of the mouth
  • Skips the slow process of stomach and intestine, and might even skip liver and Kidney as well
• The loading dose persists in the body for 1 - 3 months
  • The loading dose should be followed up with on-going maintenance dosing
  • Unfortunately, many doctors fail to follow-up with the maintenance dosing.
• About 1 in 300 people have some form of a mild allergic reaction to vitamin D supplements, including loading doses
  • it appears prudent to test with a small amount of vitamin D before giving a loading dose
  • The causes of a mild allergic reaction appear to be: (in order of occurrence)
  • 1) lack of magnesium - which can be easily added
  • 2) allergy to capsule contents - oil, additives (powder does not appear to cause any reaction)
  • 3) allergy to the tiny amount of D3 itself (allergy to wool) ( alternate: D3 made from plants )
  • 4) allergy of the gut to Vitamin D - alternative = topical

has a chart showing the huge variation in response to a loading dose

Note: study on this page suggests 10,000 IU/kg
(Chart only goes up to 5,000 IU/kg)