Dosage Range

The NHMRC vitamin guidelines released in 2006 make the following recommendations for ADI:

The Al is based on the amount of vitamin D required to maintain serum 25(OH)D at a level of at least 27.5 nmol/L with minimal sun exposure. The level has been raised in the 51-70 year age group to account for the reduced capacity of the skin to produce vitamin D with ageing. The higher level recommended in the over 70 years group was made because this group tends to have less exposure to sunlight. ACCORDING TO CLINICAL STUDIES (D2 supplemental form unless otherwise indicated.)

• Uncomplicated rickets: 1600 lU/day for the first month, gradually reducing the dose to 400 IU.

• Osteomalacia: 36 000 lU/day with calcium supplementation.

• Rickets and osteomalacia due to defective metabolism: 50 000-300 000 lU/day.

• Pregnancy supplementation: two large doses of 600 000 IU in the 7th and 8th months (Marya et al 1981).

• Reduction in fractures associated with osteoporosis: prevention of fractures has resulted from as little as 200 lU/day in combination with calcium (Hunter et al 2000).

• Reduction in falls: 1200 mg/day calcium plus 800 IU/day cholecalciferol.

• Hyperparathyroidism: 2.5-6.25 mg/day.

• Hepatic osteodystrophy: 4000 IU/day.

• Anticonvulsant osteomalacia: 4000 IU D2/day for 105 days, followed by 1000 IU/day.

• Systemic scleroderma: 0.75-1.25 fjg D3 for 6 months. TOXICITY

Toxic ingestion of prescribed forms of vitamin D or excessive dietary consumption of either D2 or D3 has been reported in the vicinity of 50 000-100 000 IU/day or 10 000 IU taken routinely for several months. Obtaining such enormous amounts from unfortified foods is improbable. The resultant hypercalcaemia manifests as anorexia, nausea, vomiting, polyuria, muscle pain, unusual tiredness, dry mouth, persistent headache and secondary polydipsia. Over extended periods of time this state of hypervitaminosis can result in metastatic calcification of soft tissues including kidney, blood vessels, heart and lungs. Symptoms and signs at this later stage include cloudy urine, pruritis, drowsiness, weight loss, sensitivity to light, hypertension, arrhythmia, fever and abdominal pain. Toxic levels cannot be obtained from excessive sun exposure (FAO/WHO 2002, Groff & Gropper 2005).

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