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Esophageal Cancer surgery helped by 300,000 IU of Vitamin D – RCT Sept 2018

Vitamin D to Prevent Lung Injury Following Esophagectomy-A Randomized, Placebo-Controlled Trial.

Crit Care Med. 2018 Sep 14. doi: 10.1097/CCM.0000000000003405. [Epub ahead of print]
Parekh D1,2,3, Dancer RCA1,4, Scott A1, D'Souza VK1, Howells PA1, Mahida RY1, Tang JCY5, Cooper MS6, Fraser WD5, Tan L7, Gao F1,4, Martineau AR 8, Tucker O1,4, Perkins GD3,4, Thickett DR1,2.

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Esophageal Cancer


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Overview Loading of vitamin D contains the following

If a person is, or is suspected to be, very vitamin D deficient a loading dose is typically given

  • Loading = repletion = quick replacement (previously known as Stoss)
  • Loading doses range in size from 100,000 IU to 1,000,000 IU of Vitamin D3
  • The size of the loading dose is a function of body weight - see below
    Unfortunately, some doctors persist in using Vitamin D2 instead of D3
  • Loading may be done as quickly as a single day, to as slowly as 3 months.
    It appears that spreading the loading dose over 4-20 days is a good compromise
  • Loading is typically oral, but sometimes by injection (I.M,)
  • The loading dose persists in the body for about 3 months
    The loading dose should be followed up with continuing maintenance
    Unfortunately, many doctors fail to follow-up with the maintenance dosing.
  • As about 1 in 300 people have some form of mild allergic reaction to vitamin D supplements,
    it appears prudent to test with a small amount of vitamin D before giving a loading dose
  • The causes of a mild allergic reaction appear to be: (in order of occurance)
    1) lack of magnesium - which can be easily added
    2) allergy to capsule contents - oil, additives (powder does not appear to cause any reaction)
    3) allergy to the tiny amount of D3 itself (allergy to wool) ( alternate: D3 made from plants )
Loading dose: 131 studies at VitaminDWiki

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OBJECTIVES:
Observational studies suggest an association between vitamin D deficiency and adverse outcomes of critical illness and identify it as a potential risk factor for the development of lung injury. To determine whether preoperative administration of oral high-dose cholecalciferol ameliorates early acute lung injury postoperatively in adults undergoing elective esophagectomy.

DESIGN: A double-blind, randomized, placebo-controlled trial.

SETTING: Three large U.K. university hospitals.

PATIENTS: Seventy-nine adult patients undergoing elective esophagectomy were randomized.

INTERVENTIONS: A single oral preoperative (3-14 d) dose of 7.5 mg (300,000 IU; 15 mL) cholecalciferol or matched placebo.

MEASUREMENTS AND MAIN RESULTS:
Primary outcome was change in extravascular lung water index at the end of esophagectomy.
Secondary outcomes included

  • PaO2:FIO2 ratio,
  • development of lung injury,
  • ventilator and organ-failure free days,
  • 28 and 90 day survival,
  • safety of cholecalciferol supplementation,
  • plasma vitamin D status (25(OH)D, 1,25(OH)2D, and vitamin D-binding protein),
  • pulmonary vascular permeability index, and
  • extravascular lung water index day 1 postoperatively.

An exploratory study measured biomarkers of alveolar-capillary inflammation and injury.
Forty patients were randomized to cholecalciferol and 39 to placebo. There was no significant change in extravascular lung water index at the end of the operation between treatment groups (placebo median 1.0 [interquartile range, 0.4-1.8] vs cholecalciferol median 0.4 mL/kg [interquartile range, 0.4-1.2 mL/kg]; p = 0.059).
Median pulmonary vascular permeability index values were significantly lower in the cholecalciferol treatment group (placebo 0.4 [interquartile range, 0-0.7] vs cholecalciferol 0.1 [interquartile range, -0.15 to -0.35]; p = 0.027).
Cholecalciferol treatment effectively increased 25(OH)D concentrations, but surgery resulted in a decrease in 25(OH)D concentrations at day 3 in both arms. There was no difference in clinical outcomes.

CONCLUSIONS:
High-dose preoperative treatment with oral cholecalciferol was effective at increasing 25(OH)D concentrations and reduced changes in postoperative pulmonary vascular permeability index, but not extravascular lung water index.

This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Created by admin. Last Modification: Tuesday September 18, 2018 12:17:25 GMT-0000 by admin. (Version 4)

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