Critical Care 2014, 18:611 doi:10.1186/s13054-014-0611-0
Anne-Françoise Rousseau1 Anne-Françoise Rousseau afrousseau at chu.ulg.ac.be and Etienne Cavalier2
1 Burn Centre and General Intensive Care Department, University of Liège, University Hospital, Sart-Tilman, Liège, B-4000, Belgium
2 Clinical Chemistry Department, University of Liège, University Hospital, Sart-Tilman, Liège, B-4000, Belgium
The problem of vitamin D deficiency during intensive care requires a number of clarifications. Initially, it is essential to focus on the fundamentals of vitamin D status assessment. Total 25-hydroxyvitamin D (25OH-D) is currently considered as the best indicator of vitamin D status. Due to practical reasons (less knowledge needed, higher throughput), immunoassays are generally preferred to measure serum 25OH-D levels. In the critical care context, however, they may be biased due to matrix effects . During the acute phase of critical care, these assays should then be abandoned in favor of liquid chromatography-tandem mass spectrometry. Moreover, standardization of vitamin D assays is crucial: such a process is ongoing worldwide but, to date, is still incomplete. It is important to note that both points are rarely considered in the published studies related to vitamin D in critically ill patients: the data may thus be interpreted with caution.
The bioavailable and free fraction of 25OH-D are attractive complementary markers of vitamin D status; however, progress is needed before establishing their evidence . We need an accurate assay rather than formulas to measure free and bioavailable concentrations. We also need to determine normal or optimal ranges and to investigate their clinical impact. In the future, it seems important to consider these analytical prerequisites when studying vitamin D in critically ill patients. Meanwhile, these patients should benefit from the potential beneficial effects of vitamin D. Cholecalciferol is, in fact, a cheap medication with a wide therapeutic window. We believe that the critically ill should be supplemented with vitamin D as they are clearly at risk of deficiency. Meanwhile, for specific protocols, intensivists should at least follow the Endocrine Society guidelines ,.
- Rousseau AF, Damas P, Janssens M, Kalin S, Ledoux D, Le Goff C, Gadisseur R, Delanaye P, Cavalier E:
Critical care and vitamin D status assessment: what about immunoassays and calculated free 25OH-D?
- Clin Chim Acta 2014, 437:43-47. PubMed Abstract | Publisher Full Text OpenURL
- De Pascale G, Quraishi SA: Vitamin D status in critically ill patients: the evidence is now available!
- Crit Care 2014, 18:449. PubMed Abstract | BioMed Central Full Text OpenURL
- Heaney RP, Holick MF: Why the IOM recommendations for vitamin D are deficient.
- J Bone Miner Res 2011, 26:455-457. PubMed Abstract | Publisher Full Text OpenURL
- Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM:
Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline.
- J Clin Endocrinol Metab 2011, 96:1911-1930. PubMed Abstract | Publisher Full Text OpenURL
- Trauma and surgery category listing with associated searches
- Search VitaminDWiki for ICU OR “critical care” OR “intensive care” OR “acute care” 494 items as of Nov 2014
- Vitamin D intervention increased by 20 percent the survival of critically ill patients- RCT June 2014
- When It Comes to Raising Vitamin D Levels, Anesthesiologists Advised—"Don't Be Wimpy!" – Sept 2014
- Hospitalization consumes vitamin D in children – March 2014
- US Army learning about benefits of vitamin D to trauma – Dec 2013
- Review of Vitamin D (including free, frequency, injection, how much.) – Sept 2013
- Getting Vitamin D into your body shows many ways - most of which can provide a quick loading doset
- Overview Loading of vitamin D
- 540000 IU before ICU raised vitamin D by 25 ng in 2 days – March 2011
- Guideline following hip fracture – 50000 IU vitamin D daily for 7 days – Jan 2013
- ICU survival increased with vitamin D single 540K IU loading dose - JAMA Sept 2014 540,000 IU loading dose
Vitamin D helped those 42% who had very low levels when entering the ICU