Prevention of rickets with single massivedoses of vitamin D

Summary Although single massive doses of vitamin D were used experimentallyas early as 1928 for the prevention of rickets in experimental animals, it was not until 1938 that this method of rickets prophylaxis was applied to infants. Since that time numerous workers in Germany and elsewhere have utilized this procedure with effective results. When at least 400,000 to 600,000 U.S.P. units of vitamin D were administered orally or parenterally to normal or premature infants even as young as one month, effective protection against rickets for the duration of about five winter months occurred. These workers stressed the safety of this method. In this series, seventy-five infants were given 600,000 U.S.P. units of an electrically activated preparation of ergosterol (ertron), divided in two oral doses in precooked cereal and milk at about the third to the fifth month of life. Only sixty-two of these infants could be followed throughout the entire period. At the onset of the study, eighteen showed mild rickets which healed during the period of observation of from two to seven months after treatment and remained healed. Forty-four other infants were followed for from two to seven months after the single massive dose of vitamin D and showed no evidence of rickets during this observation period. Massive doses of vitamin D administered in the form of electricallyactivated ergosterol (ertron) were well tolerated, and no toxic manifestations were observed, such as loss of weight, vomiting, or anorexia. Rather, these infants thrived exceptionally well. No diminution in the incidence of respiratory infections was noted. There is no danger in administering single massive doses of vitamin D to young infants, even premature infants. The danger lies in repeating these large doses over a period of time so that several million units of vitamin D are given. Depending on the age and weight of the infant, such large doses may be toxic if repeated daily. Two plans for administering single massive vitamin D prophylaxis against rickets are outlined. One is to protect the infant until 2 or 3 months of age by means of daily prophylactic doses of 1,000 units of vitamin D and then to administer a single dose of 600,000 units of vitamin D. The latter dose may be repeated from four to six months later. The other plan is to give an infant at 1 and 2 months of age, respectively, 50,000 units of vitamin D in formula, and then at about 3 months of age to administer a single dose of 600,000 units in precooked cereal, which single dose may be repeated from four to six months later. There is experimental evidence to show that vitamin D when given in single massive doses is stored in the blood plasma and the tissues for a period of weeks or months. This experimental evidence is borne out by the clinical observations of this series of cases and others. The oral single massive dose prophylaxis of rickets is to be preferred to parenteral injection for the average case. Only in cases of severe intestinal disturbances or in the case of young premature infants whose absorption may be poor does it seem necessary to use the parenteral method. The administration of a single massive dose of vitamin D for the prophylaxis of rickets is not only of proved effectiveness, but also is safe and time-saving.