From 7th Space interactive reporting on Critical Care 2011, 15:R104]
Short-term effects of high-dose oral vitamin D3 in critically ill vitamin D deficient patients: a randomized, double-blind, placebo-controlled pilot study
IntroductionVitamin D deficiency is encountered frequently in critically ill patients and might be harmful. Current nutrition guidelines recommend very low vitamin D doses.
The objective of this trial was to evaluate the safety and efficacy of a single oral high-dose vitamin D3 supplementation in an intensive care setting over a one-week observation period.
Methods: This was a randomized, double-blind, placebo-controlled pilot study in a medical ICU at a tertiary care university center in Graz, Austria. Twenty-five patients (mean age 62 +/- 16yrs) with vitamin D deficiency [25-hydroxyvitamin D(25(OH)D) (less than or equal to) 20 ng/ml] and an expected stay in the ICU >48 hours were included and randomly received either 540,000 IU (corresponding to 13.5 mg) of cholecalciferol (VITD) dissolved in 45 ml herbal oil or matched placebo (PBO) orally or via feeding tube.
Results: The mean serum 25(OH)D increase in the intervention group was 25 ng/ml (range 1-47 ng/ml).
The highest 25(OH)D level reached was 64 ng/ml, while two patients showed a small (7 ng/ml) or no response (1 ng/ml). Hypercalcemia or hypercalciuria did not occur in any patient.
From day 0 to day 7, total serum calcium levels increased by 0.10 (PBO) and 0.15 mmol/L (VITD; P <0.05 for both), while ionized calcium levels increased by 0.11 (PBO) and 0.05 mmol/L (VITD; P <0.05 for both). Parathyroid hormone levels decreased by 19 and 28 pg/ml (PBO and VITD, ns) over the seven days, while 1,25(OH)D showed a transient significant increase in the VITD group only.
Conclusions: This pilot study shows that a single oral ultra-high dose of cholecalciferol corrects vitamin D deficiency within 2 days in most patients without causing adverse effects like hypercalcemia or hypercalciuria.
Further research is needed to confirm our results and establish whether 25(OH)D supplementation can affect the clinical outcome of vitamin D deficient critically ill patients.
EudraCT Number: 2009-012080-34 German Clinical Trials Register (DRKS): DRKS00000750
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Crit Care. 2011 Mar 28;15(2):R104.
Amrein K, Sourij H, Wagner G, Holl A, Pieber TR, Smolle KH, Stojakovic T, Schnedl C, Dobnig H.
Medical University of Graz, Department of Internal Medicine, Division of Endocrinology and Metabolism, Auenbruggerplatz 15, 8036 Graz, Austria. harald.dobnig at medunigraz.at.
Two patients in the VITD group demonstrated either a small (7 ng/ml) or no (1 ng/ml) increase in 25(OH)D levels.
In one patient, this may be attributable to gastrointestinal dysfunction after hypoxia related to near-drowning and resuscitation, and in the other to a history of sclerodermiform gastrointestinal graft-versus-host disease after allogeneic stem cell transplantation. Individual patient data are given in Table 3.
The progressive increase in 25(OH)D levels may not only be explained by initial differences in intestinal absorption of vitamin D3, but also by limited capacity of the vitamin D binding protein transport system, or that of the liver to hydroxylate the precursor. Moreover, there may be interindividual differences applying to storage effects, whereby cholecalciferol is taken up or released by adipose and muscle tissues. However, most of the vitamin D that enters the body is catabolized and excreted without ever being stored in tissues, and without ever becoming 25(OH)D . We thus cannot exclude that either a change towards smaller dosages or more frequent dosing intervals may also have yielded the desired effects and normalized 25(OH)D levels.
27. Lawson DE, Sedrani SH, Douglas J: Interrelationships in rats of tissue pools of cholecalciferol and 25-hydroxycholecalciferol formed in u.v. light. Biochem J 1986, 233:535-540.
My advice is to have some 50,000 IU capsules from Bio Tech Pharmacal on hand in the house, in the medicine cabinet not the vitamin cabinet.
If someone you love is in the hospital (not just the ICU) and they have not been taking adequate doses of vitamin D,
give them 50,000 to 100,000 IU/day for the first 3-4 days of their hospitalization.
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- All items in After surgery or trauma
- Will lots of vitamin D help in ICU – RCT Nov 2012 same study
- ICU time is 2X more likely to be longer than 2 days if vitamin D less than 20 ng – Mar 2011
- Health Care Providers save $ by providing vitamin D before and/or after surgery or trauma - reduces the time in bed, etc.