Vitamin D treatment and toxicity: primum non nocere.

We read with interest the recent review article on Vitamin D deficiency and treatment in childhood [1]. Intermittent dosing with Stoss regimens is effective in the treatment and prevention of vitamin D deficiency, is much more economical than daily dosing, and ensures supervised administration and compliance. However, stoss does not necessarily mean large. Stoss (German for “bump up”) effect can be obtained with smaller doses than those used currently by pediatricians in India. Caution needs to be exercised as vitamin D is fat soluble and accumulates in the body. The resulting hypercalcemia can be life threatening and hypercalciuria can result in nephrocalcinosis and renal failure.