Dosing Error With Over-the-Counter Vitamin D Supplement

Abstract

Vitamin D, the “sunshine vitamin,” is back in the limelight.1 Reemergence of rickets among vulnerable infants (dark-skinned and/or breast-fed without vitamin D supplementation) and reports of excessive prevalence of vitamin D deficiency and insufficiency among children have reemphasized the importance of optimal intakes of vitamin D.2–5 The American Academy of Pediatrics (AAP) increased its recommended dietary allowance (RDA) of vitamin D for the prevention of vitamin D deficiency in infants and children from 200 IU to 400 IU in 2008.6–7 Recently, the Institute of Medicine (IOM) revised its RDA for vitamin D from 200 IU to 400 IU in infants (0 to 12 months) and from 200 IU to 600 IU in children (1 to 8 years).8 Without fortification, very few foods are rich in vitamin D. Humans meet their vitamin D needs from sunlight exposure, diet and/or supplements. Of these sources, photosynthesized vitamin D is the major contributor to human vitamin D status.9–11 Vitamin D-fortified milk and infant formula remains the main dietary source of vitamin D. An infant or a child must drink 4 servings (1 liter or 32 ounces) of vitamin D-fortified milk to meet the AAP recommended intake of vitamin D (400 IU/day), which seems to be a tall order for many. Therefore, vitamin D supplements become an important source of dietary vitamin D. In order to meet consumer desires to prevent deficiencies or optimize health benefits related to vitamin D, preparations of higher concentrations of over-the-counter vitamin D supplements have become readily available for the general public, with the potential for inadvertent overdosing in young infants and children.