Is the GP mistaken?

[CherryBlossom321]

My 13 year old has a vitamin D deficiency. The GP has prescribed 10,000IU per day, which seems to go against the standard recommended dose for deficiency especially for younger people. I know that overdosing on vitamin D can cause hypercalcemia and be quite dangerous. Should I seek a second opinion?

For a severely deficient 13 year old, it’s a common short term dose for 6-12 weeks, usually followed by a lower maintenance dose.
How deficient are they? They must feel dreadful. Were their other blood tests okay? Vit D deficiency can go hand in hand with other deficiencies if, for example, there are thyroid issues or if they have had covid.
B12/folate and ferritin can also be affected in those instances.

You could ask the pharmacist, their whole role is checking this sort of thing and they can check with paediatric pharmacist in hospital if needed.

BNF for Children is the standard formulary, you could check against that in the meantime?

bnfc.nice.org.uk/drugs/ergocalciferol/#indications-and-dose

He said her Vitamin D is at 16. Her ferritin level is 3 ☹️ So she’s also been prescribed ferrous fumerate. She has ARFID. She is very tired and pale. I’m concerned about the risk of hypercalcemia as it can heart and kidney damage, and I’m scared of anything else going wrong with her health.

If she’s severely deficient then a high dose for the short term is normal.

Adults quite commonly have 20,000 per day as a ‘loading dose’ when severely deficient, so I would think half that is probably right for a teenager. It will only be short term, a maintenance dose (if she needs one) would be much lower.

Thank you for the replies, this is reassuring.

Standard loading regimen

Thank you!

The low ferritin will also be making your child tired and miserable. If your DD gets side effects from the iron, you can take it at bedtime (avoids stomach aches/cramps). Or go to alternate day dosing.

Normally I would suggest taking the iron with a small glass of orange juice but that might be difficult with arfid?

Ferritin of 3 is just awful. I hope the tablets work. I know ARFID is really hard, do you have any support for that at all?

That prescription is as per the BNFc, which is the doses bible. Colecalciferol | Drugs | BNFC | NICE

I know, I’m devastated for her. My own ferritin level is 5 and I’m not tolerating any form of supplement currently. I’m worried she may also suffer in that way too. She’s under the dietitian at the local paediatric clinic, but we just get suggestions of things to add to her diet that she can’t eat. CAMHS have rejected referrals three times. I’m hoping to access private therapy, but the soonest we can afford to do that will be September.

I also can’t tolerate supplements so I’ve had an iron infusion which made an enormous difference. Maybe you could be eligible for one at such low ferritin? Your DD prob is too.

I’ve been told by the GP that the only route in my area to get one is via either gynaecology (where I’ve been referred back to repeatedly over the years for very heavy periods before they eventually shrug their shoulders and discharge me), or gastroenterology if they find a problem there. Looked into it privately, but it would be £800 at our local bupa hospital. It all feels a bit hopeless.

That’s absolutely mad. Here in Switzerland you just ask for one and you can have it (provided your ferritin is under 30)

Yes, there are a lot of people just being left in this condition 😕