Aquadetrim drops d/pr. orally 15000IU/ml in vial. with cap 10ml per pack. No. 1 (cholecalciferol)

Without this group of biologically active substances (including cholecalciferol and ergocalciferol), the functioning of many organs is impossible. With a vitamin deficiency, bones become brittle and brittle - this is the first sign of vitamin deficiency.

Residents of countries where there is a lot of sunshine are practically not threatened by shortages. Their body synthesizes the vitamin thanks to the rays of the sun. In countries where there is little sun, vitamin D deficiency is often diagnosed.

What causes vitamin D deficiency?

Vitamin D deficiency in many Russian residents is due to:

• location in the northern temperate zone (above 42 degrees north latitude)
• limited exposure to the sun (office work, driving cars)
• eating meat from animals that have not been exposed to the sun (farm)
• use of sunscreens
• chronic diseases (obesity, intestinal pathology, taking a large number of medications)

You can determine the level of vitamin D in your body by taking the following test:

25-OH vitamin D (25-hydroxycalciferol) (amount)

Indications for use

Let's consider the main conditions in which it is necessary to replenish vitamin D3 for preventive or therapeutic purposes.

In children:

1. Disturbances in the growth and development of bones and joints, skeleton.
2. Risk of rickets.
3. Signs of vitamin deficiency.

Important! Before taking it, it is recommended to take a blood test to confirm the level of the substance. Based on the results of the examination, the doctor will make an individual prescription, taking into account the patient’s age, indications, place of residence, type of activity, concomitant pathologies, etc.

In adults:

1. Presence of signs of vitamin D deficiency.
2. Pregnancy and breastfeeding (to prevent pathologies of fetal development).
3. Complaints of muscle cramps, spasms.
4. Osteoporosis, joint damage, bone fractures.
5. Calcium and phosphorus deficiency, poor absorption.
6. Bone marrow diseases.
7. Complex treatment of cardiovascular system, gastrointestinal tract.
8. Enterocolitis.
9. Comprehensive treatment of systemic lupus erythematosus, skin tuberculosis, type 2 diabetes, psoriasis.
10. Prevention of occupational diseases (in metallurgy).
11. Hypoparathyroidism.
12. Prescription of glucocorticosteroids.
13. Decreased immunity, frequent seasonal diseases.

Important! The use of vitamin D without tests and doctor's prescription is possible only for preventive purposes.

For the curious

Vitamin D

combines a group of vitamins (D1, D2, D3, D4, D5), of which only two forms (D2 and D3) have important biological significance.

The main biological role of calcitriol

(1,25-OH-vitamin D) is to maintain a constant level of calcium in the blood (vitamin D enhances the absorption of calcium in the intestines and, if there is not enough calcium in the blood, ensures the flow of calcium from the bones into the blood).

Over time, receptors for calcitriol, in addition to the intestines and bones, were found in the kidneys, genitals, pancreas, muscles, cells of the immune and nervous systems. Thus, it became clear that vitamin D performs a large number of different functions in the human body:

• regulates the expression of 3% of the human genome (several thousand genes)
• increases the sensitivity of the insulin receptor (prevention of insulin resistance, obesity, diabetes)
• strengthens the skeletal system
• reduces the level of parathyroid hormone in the blood
• promotes the synthesis of sex hormones (testosterone, estrogens, progesterone)
• improves reproductive function
• affects innate and acquired immunity
• prevents the development of tumors, depression, Parkinson's disease

Sources of vitamin D3

The peculiarity of this substance is that our body receives it from two sources:

• Firstly, it is produced in our skin under the influence of ultraviolet rays. This is why walking on sunny days is so beneficial. It is not necessary to be under the scorching sun. In the shade of trees the same effect will occur. Just a 20-minute walk with your face and palms open is enough to provide yourself with cholecalciferol for several days.
• Secondly, the source of this substance is food. It is found in significant quantities in fish, caviar and eggs.

Vitamin D deficiency

A lack of vitamin D in the body can lead to the development of:

• diseases of the cardiovascular system
• immunodeficiency, allergies, psoriasis, bronchial asthma, rheumatoid arthritis
• periodontal disease
• tumors of the large intestine, mammary glands, ovaries, prostate
• chronic fatigue, depression, insomnia
• decreased muscle strength leading to a risk of falls
• decreased motility and number of morphologically normal sperm (male factor infertility)
• risk factor for premature birth, fetopathies (less than 20 ng/ml)

Achieving a vitamin D level of 50 ng/ml (125 nmol/l) reduces the risk of developing:

Vitamin D is important during pregnancy.

Its deficiency is associated with the risk of developing gestational diabetes mellitus, premature birth, preeclampsia, and various intrauterine developmental defects.

There is not a single case of teratogenic (leading to the development of tumors) effect of vitamin D in the world.

Prevention

For the purpose of prevention, the officially recommended dose of vitamin D is taken, which is 800 units. 1-2 times a week. This amount is sufficient to maintain normal phosphorus-calcium metabolism. The safe dose for prevention is 2000 units; such a dose can be prescribed by a specialist if there are certain indications.

Attention!

For medical indications, a therapeutic dose is indicated, which is also determined by the attending physician. Such doses are prescribed for patients with diabetes mellitus, cancer, obesity, atherosclerosis, and also in the presence of a pronounced inflammatory process in the body.

The medical literature contains data on the improvement of the condition of cancer patients and the recovery of patients with significantly reduced immunity who took high doses of vitamin D (up to 5000 IU). In any case, the therapeutic dosage is determined only by a specialist.

The doctor recommends a therapeutic dosage and number of doses based on test results (vitamin D and calcium levels are determined). Patients with gastritis, peptic ulcers, or kidney stones are prohibited from taking the drug without a doctor's prescription. In addition, with frequent bone fractures and early diagnosed osteoporosis (patient age under 45-50 years), taking any vitamins and minerals without consulting a doctor is also prohibited.

Vitamin D standards

Considering the different units of measurement, the recommended level is:

60 - 100 ng/ml

150 – 250 nmol/l

To convert from ng/ml to nmol/l you need ng/ml * 2.5 = nmol/l

Example: 30 ng/ml * 2.5 = 75 nmol/l

Russian Association of Endocrinologists

considers
the optimal concentration
of vitamin D in the blood of an adult to be 30-100 ng/ml,
deficiency is
20-30 ng/ml,
deficiency
is less than 20 ng/ml.

According to data presented at the 10th European Congress on Menopause and Andropause (Madrid, 2015), vitamin D levels in obese patients in Russia:

less than 20 ng/ml - 35%

20-30 ng/ml - 30%

more than 30 ng/ml - 35%

Daily Values ​​for Vitamin D

according to the recommendation of the American Society of Endocrinology (2011).

Prophylactic dose

vitamin D (when you can not detect it in the blood and take it calmly) is considered to be 4,000 IU per day.

Without medical supervision, it is not recommended to take vitamin D at a dose of 10,000 IU for more than 6 months. (Russian Association of Endocrinologists)

It is almost impossible to overdose on vitamin D. For example, in Holland, an elderly couple (90 and 95 years old) accidentally took a single dose of cholecalciferol 2,000,000 IU each.

Doctors monitored them for 2 months and did not identify any symptoms of overdose or toxicity. The maximum blood concentration of its form of 25-OH-vitamin D on day 8 was 210 and 170 ng/ml, respectively, which is slightly higher than its target values.

Vitamin D overdose: symptoms and consequences

Vitamin D is a biologically active substance that is extremely actively involved in many physiological reactions occurring in the human body, in particular, it is a direct participant in calcium and phosphorus metabolism. Moreover, calcium metabolism is important not only for bone density, which we all know. This mineral and vitamin D in an inextricable complex with it have a beneficial effect on the functioning of the heart and blood vessels, reducing the likelihood of a heart attack and coronary heart disease. In addition, vitamin D takes part in the formation of immunity, and not only anti-infectious immunity: calciferol activates the activity of the immune system, aimed at protecting against the occurrence of cancer pathologies. Vitamin D affects hormonal metabolism and even mood, not to mention a number of other physiological processes.

Vitamin D is found in some foods, and it is also formed in human skin when it is irradiated with ultraviolet rays. However, this is not enough, and additional vitamin D intake is necessary for adequate functioning of the organs and systems of the human body.

Is it possible to overdose on vitamin D? I would like to immediately emphasize that this situation belongs to the category of casuistic and occurs extremely rarely - for example, when, instead of measuring the solution in drops, a person for some reason measures it in teaspoons or chronically forgets that he took the supplement and takes it again, again and again.

This situation is also possible if, instead of the intermediate metabolite - cholecalciferol - one takes active metabolites of vitamin D in high dosages. However, given the low probability of a possible overdose, let's figure out how to recognize its symptoms in time in adults and children, and what to do if such a condition occurs.

Routes of vitamin D entry into the human body

A person can provide his body with calciferol from three sources: synthesis in the skin, from food, and taking dietary supplements with vitamin D. Let's consider each of these sources in more detail.

Synthesis in the body is one of the sources of calciferol. The process of synthesis occurs in the skin when it is exposed to natural or artificial ultraviolet irradiation. However, this source of vitamin D also has its pitfalls. In order for calciferol to be actively synthesized, the sun's rays must fall on the Earth at a certain angle. At the same time, the main part of the Russian territory is located north of latitude 42, that is, it lacks sunlight. In addition, melanin protects the skin from ultraviolet radiation - that is, in people with dark or tanned skin, the synthesis of calciferol slows down. And finally, we must not forget that ultraviolet radiation is a powerful carcinogen and contributes to the occurrence of skin cancer. Extending the time spent in the sun or prolonged tanning in a solarium, refusing sunscreens in order to compensate for calciferol deficiency can ultimately lead to the development of melanoma.

Food - Some foods contain vitamin D in fairly large quantities. Such products include salmon fish, cod liver, and fatty herring. However, it should be recognized that such products are not daily in our country, with the exception, perhaps, of herring, but it is consumed mainly salted, which is why an attempt to compensate for the calciferol deficiency may result in an excess intake of dietary salt into the body. Calciferol can also be obtained from fatty cheeses (such as Swiss), butter and chicken eggs, but these products contain significantly less calciferol than fish.

Problems with obtaining calciferol from food arise in people following a vegetarian diet: plant foods contain negligible amounts of vitamin D. The only relatively rich plant source of calciferol is mushrooms (chanterelles and morels).

Vitamin D supplements: In conditions of lack of sunlight and foods rich in calciferol, vitamin complexes and supplements become the only reliable source of vitamin D.

Can excess vitamin D occur when obtained naturally? Extremely unlikely! Even daily consumption of fatty fish cannot lead to an excess of vitamin D in the body. By the way, this diet is typical mainly for northern countries. In this way, people have adapted to compensate for the lack of sunlight. Intense solar radiation also cannot cause excess calciferol because under the influence of ultraviolet radiation, melanin accumulates in the skin - a natural skin defense that inhibits the process of vitamin D synthesis.

But a person can consume artificial vitamin supplements in excess, thus provoking an overdose. Often, an overdose occurs due to careless intake of supplements or the frivolous belief that “you can’t spoil the porridge with oil, but there’s no need for extra vitamins.” Therefore, it is important not only to adhere to the recommended dosage and doctor’s instructions, but also to compare it with your sun activity and diet. If you are in doubt about the dosage, it is better to consult your doctor.

Daily requirement for vitamin D

The amount of vitamin D a person needs for the normal functioning of his body is directly related to the person’s age. The table below shows the recommended optimal and maximum dosages of calciferol. Moreover, it is important to take into account that this figure indicates the total amount of vitamin - both obtained from food or vitamin supplements, and synthesized in the skin in sunlight.

Symptoms of vitamin D overdose

When it comes to the manifestations of excess calciferol in the body, remember that overdose can be either acute (a single dose of too much vitamin D) or chronic (long-term use of high doses of calciferol in combination with a diet rich in vitamin D and / or intense sun exposure). . According to the type of overdose, the following manifestations are distinguished.

Signs of acute vitamin D overdose:

• intense thirst;
• increased urination;
• nausea and vomiting;
• lack of appetite;
• a sharp decrease in body weight due to dehydration;
• convulsions due to dehydration and mineral metabolism disorders;
• a sharp decrease in blood pressure, heart rhythm disturbances;
• sleep disturbances, sleep inversion (drowsiness during the day and insomnia at night).

Signs of acute vitamin D overdose in an infant:

• vomiting, regurgitation after feeding;
• frequent urination;
• liquid stool with a pungent odor;
• convulsions;
• dry skin, rashes, peeling;
• loss of body weight;
• decreased skin elasticity.

Signs of chronic vitamin D overdose:

• state of chronic fatigue, fatigue;
• irritability, inability to concentrate;
• decreased appetite;
• disorders of the gastrointestinal tract, stool disorders, dyspeptic symptoms;
• gradual loss of body weight without a clear reason;
• lower back pain, swelling;
• leg muscle cramps;
• moderate pain in bones and joints;
• sleep disorders, sleep inversion.

Signs of chronic vitamin D overdose in an infant:

• tearfulness, irritability, chronic sleep disturbance;
• pale skin, decreased skin turgor;
• slow weight gain, height;
• hair loss or slow hair growth;
• arrhythmia;
• accelerated overgrowth of fontanelles.

The danger of vitamin D overdose

Calciferol is a fat-soluble compound, so if it is overdosed, the body cannot quickly remove excess vitamin D in the urine. With prolonged use of its increased doses, calciferol gradually accumulates in the body, provoking serious metabolic disorders. In particular, calcium deposition in body tissues.

At the same time, excess calcium affects different organs differently:

• in the cardiovascular system, excessive amounts of calcium are a factor in the development of atherosclerosis at an early age, increasing the risk of blood clots in blood vessels and even cardiac arrest. In addition, hypervitaminosis D is considered one of the causes of toxic damage to the heart muscle;
• in the urinary system, excess calcium can cause the appearance of calcium stones in the lumen of the kidneys, ureters, and bladder. Urolithiasis is a serious complication of hypervitaminosis D; stones not only provoke intense pain, but can block the lumen of the urinary organs, in which case the patient may need emergency surgical intervention;
• In the tissue of the glands, with an excess of calciferol, compactions can form - calcifications. They are fraught with disruption of the structure and function of the gland and can clog the excretory ducts with the formation of cysts, which can then fester. For example, calcifications of the mammary gland can cause false diagnosis of neoplasms, and if calcifications occur during lactation, they can lead to stagnation of milk - lactostasis and inflammation of the mammary gland - mastitis. Calcifications in the pancreas are dangerous due to the occurrence of congestive pancreatitis and even pancreatic necrosis - a dangerous condition in which pancreatic tissue is destroyed by its own enzymes;
• in the nervous system, the process of mineral metabolism is disrupted, and with it the transmission of nerve impulses along the nerve fiber, as well as the restoration of nervous tissue;
• Calcifications may also form in the liver tissue. In addition, an excess of calciferol is fraught with toxic damage to the liver tissue with subsequent inflammation - the formation of toxic hepatitis;
• in the musculoskeletal system, excess calcium leads to increased stiffness and fragility of bones, the occurrence of pathological fractures, the development of osteochondrosis, arthrosis;
• in the endocrine system, significant disruptions in the functioning of the glands are possible, since calciferol is involved in the process of production and transformation of a number of hormones and biologically active substances;
• in eye tissues, excess calciferol can provoke clouding of the cornea and lens, leading to the development of blindness.

One of the most dangerous conditions associated with an overdose of vitamin D is hypercalcemic crisis. It manifests itself as dyspeptic symptoms (nausea, vomiting, bloating, stool disorders), intense wandering pain in the muscles, joints, and bones. Bleeding from the digestive tract is common. There may be a persistent increase in blood pressure or, conversely, a drop, even to the point of collapse.

Consequences of vitamin D overdose for children

Overdose of calciferol in children is somewhat more common than in adults. The causes of this condition may vary. Often, an overdose occurs due to the carelessness of parents, who may mistakenly give the baby an “adult” dosage or their erroneous belief that the more vitamin the baby receives, the better for him.

In preschool and primary school age, the cause of acute and chronic intoxication with calciferol can be the child’s independent uncontrolled intake of the supplement.

Possible consequences of acute and chronic overdose of calciferol in children:

• slower growth and development of the child;
• chronic dehydration of the body;
• impaired development of bone tissue, early closure of fontanelles, premature ossification of growth points, resulting in short stature, bone deformities;
• decreased visual acuity, blindness;
• physical inactivity;
• irritability, tearfulness, fatigue, cognitive impairment, decreased learning ability;
• convulsive syndrome;
• decreased immunity, frequent colds.

Consequences of vitamin D overdose during pregnancy and lactation

Excessive intake of calciferol into the body leads to multiple disorders of physiological processes. This condition is fraught with spontaneous termination of pregnancy - essentially a protective reaction of the body, which rightly perceives poisoning as a threat to the life of the mother. In the later stages, an overdose of vitamin D can lead to the development of eclampsia, edema, convulsions, and fluctuations in blood pressure that are dangerous for the expectant mother. Chronic excess of calciferol during pregnancy provokes various disorders of the formation and growth of the fetus, especially its bone and excretory systems, as well as the heart and blood vessels.

An overdose of vitamin D during lactation is fraught with aggravation of disorders in the psycho-emotional sphere. A woman who has recently become a mother is quite naturally susceptible to anxiety, worries about the condition of the baby, mood swings and even depression. With an overdose of vitamin D, as well as with its deficiency, these conditions can become significantly worse.

In addition, as mentioned above, a chronic excess of calciferol is dangerous due to the appearance of calcifications in the tissues of the mammary glands, congestive mastitis and abscesses.

Help with vitamin D overdose

An overdose of calciferol is accompanied by a number of conditions that are dangerous to the health and even life of the patient. Therefore, if you suspect excess vitamin D in the body, it is recommended to seek medical help. In the case of a child (especially an infant), a pregnant woman or an elderly person, contacting a doctor should be done immediately. The decision about the conditions in which to treat the condition - outpatient or in a hospital - is made by the doctor, based on data on the condition of the victim.

In case of acute vitamin D poisoning, while awaiting medical help, measures should be taken to cleanse the victim’s body:

• rinse the stomach with boiled or bottled (still!) water or a light pink solution of potassium permanganate. The liquid should be at room temperature, the victim should be allowed to drink at least 1 liter (an adult, a child - depending on age), and then induce vomiting by pressing on the root of the tongue;
• Give the victim a sorbent, calculating its dosage based on body weight. In this case, it is better to choose drugs that do not change the color of stool (for example, activated carbon is undesirable, since it turns stool black and can thus mask intestinal bleeding)

There is no specific antidote (antidote substance) for vitamin D; treatment of calciferol poisoning is symptomatic. It includes:

• detoxification of the body (intravenous drip administration of saline, 5% glucose, 4% sodium bicarbonate solution);
• stimulation of diuresis to accelerate cleansing of the body;
• taking vitamins A, group B (especially B5, or pantothenic acid), C, which help regulate calcium metabolism and remove excess calcium from the body.

If necessary, the patient may be prescribed therapy that stimulates the functioning of the heart and blood vessels, normalizes blood pressure, takes neuro- and hepatoprotectors, antibiotics in the event of purulent complications or the addition of a secondary bacterial infection. It is important to limit foods high in vitamin D and calcium in the victim’s diet during the period of eliminating the consequences of an overdose. Of course, it is necessary to immediately stop taking calciferol medications.

Vitamin D oil or water based

Calciferol is a fat-soluble substance, so special additives are used to dissolve it in water. You can find a list of them among the excipients in the drug instructions. Stabilizers are also added to such preparations so that the solution retains its shape and preservatives, which are most often ethyl alcohol. Auxiliary components are contained in tiny doses, so you shouldn’t be afraid of this. The aqueous solution should be stored in the refrigerator.

There are cases when only an aqueous solution is suitable for children. These are babies with diseases of the intestines and pancreas who do not digest fats well.

The oil solution contains only oil and cholecalciferol. In this case, oil acts as a natural preservative. Oil-based preparations are stored at room temperature.

A healthy, non-allergic child is given any option to prevent deficiency of this substance. In any case, your pediatrician should answer the questions: which vitamin D is better - water-based or oil-based, how to give it and up to what age, and what is the correct dosage.

Zinaida Rassadina

Pediatrician, 14 years of experience

Israeli children's vitamin D3

On our website you can buy an oil-based product from two Israeli manufacturers. It is available in drops and is suitable for babies from birth. One drop contains 200 IU of vitamin. The recommended daily dose for children is 2 drops. Ask your pediatrician how many drops to give your child.

The drug from Tiptipot is available in a dark glass bottle with a drip dispenser and a safety cap with a volume of 15 ml. The drug from Life is available in a soft plastic bottle with a 20 ml drip dispenser.