High doses of ergocalciferol (vitamin D2) have been used in these patients. Despite significant improvements in vitamin D concentrations following high-dose ergocalciferol (or use of a vitamin D analog like calcitriol) alone, patients may remain hypocalcemic and hypophosphatemic.

Individualize dose based upon 25(OH)D concentrations. Active treatment may continue for 2 to 3 months to replete deficient stores, followed by maintenance dosing with the RDA. It is important to ensure adequate dietary intake of calcium and phosphorus. Large single dose regimens (5,000 to 15,000 mcg PO divided into 2 to 4 doses administered over 1 day) have been used when compliance is a concern, but are sometimes controversial due to a purported risk for hypercalcemia. Alternatively, at least 125 mcg (5,000 International Units) PO once daily has also been recommended for initial treatment weekly regimens (e.g., high doses, such as 1,250 mcg PO once weekly) or a single higher-dose course over 1 to 5 days may be considered if compliance is an issue that prevents adequate repletion. Thereafter, supplement with the RDA to prevent further deficiency.

Vitamin D supplementation should continue until the infant consumes at least 1 L/day (1 quart/day) of vitamin D-fortified milk (Whole milk (cow's milk) is not recommended until after 12 months of age).ĥ0 to 500 mcg (2,000 to 20,000 International Units) PO daily for 4 to 8 weeks, with the duration of treatment determined by evidence of radiologic healing. As infants are weaned from human milk and/or formula, intake of vitamin D-fortified milk should be encouraged to provide at least 10 mcg/day (400 International Units/day) of vitamin D. Infants who receive a mixture of human milk and formula should get a vitamin D supplement of 10 mcg/day (400 International Units/day) to ensure the AI value. Because most exclusively formula-fed infants ingest nearly 1 L/day of formula after the first month of life, they will achieve a vitamin D intake of 10 mcg/day (400 International Units/day). Infants that are exclusively breast-fed without vitamin D supplements are at increased risk for deficiency. 10 mcg/day (400 International Units/day) PO is the recommended Adequate Intake based on dietary intake of breast milk, formula, or other food sources.

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