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Inflammation or surgery or heart attack decreases measured vitamin D levels – Mar 2011

Two articles on this page claim different reasons for vitamin D levels dropping after surgery

VitaminDWiki Opinion; vitamin D is being consumed by the body after the trauma or surgery

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The relation between acute changes in the systemic inflammatory response and plasma 25-hydroxyvitamin D concentrations after elective knee arthroplasty.

Am J Clin Nutr. 2011 Mar 16.
Reid D, Toole BJ, Knox S, Talwar D, Harten J, St J O'Reilly D, Blackwell S, Kinsella J, McMillan DC, Wallace AM.
Department of Anaesthesia, Faculty of Medicine, University of Glasgow, Royal Infirmary, Glasgow, United Kingdom.

BACKGROUND: Studies indicate that low plasma 25-hydroxyvitamin D 25(OH)D is associated with a range of disease processes, many of which are inflammatory. However, other lipid-soluble vitamins decrease during the systemic inflammatory response, and this response may confound the interpretation of plasma 25(OH)D.

OBJECTIVE: The objective was to examine whether plasma 25(OH)D concentrations change during evolution of the systemic inflammatory response.

DESIGN: Patients (n = 33) who underwent primary knee arthroplasty had venous blood samples collected preoperatively and postoperatively (beginning 6-12 h after surgery and on each morning for 5 d) for the measurement of 25(OH) D, vitamin D-binding protein, parathyroid hormone (PTH), calcium, C-reactive protein, and albumin. A final sample was collected at 3 mo.

RESULTS: Preoperatively, most patients were 25(OH)D deficient (<50 nmol/L) and had secondary hyperparathyroidism (PTH > 5 pmol/L). Age, sex, body mass index, season, medical history, and medication use were not associated with significant differences in preoperative plasma 25(OH)D concentrations.

By day 2 there was a large increase in C-reactive protein concentrations (P < 0.001) and a significant decrease in 25(OH)D of ?40% (P < 0.001). C-reactive protein, 25(OH)D, and calculated free 25(OH)D had not returned to preoperative concentrations by 5 d postoperatively (all P < 0.001). At 3 mo, 25(OH)D and free 25(OH)D remained significantly lower (20% and 30%, respectively; P < 0.01).

CONCLUSION: Plasma concentrations of 25(OH)D decrease after an inflammatory insult and therefore are unlikely to be a reliable measure of 25(OH)D status in subjects with evidence of a significant systemic inflammatory response.
PMID: 21411617
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Summary by VitaminDWiki: Measured vitamin D levels dropped 40% after surgery and were still 20% lower 3 months later

Second article: Noticed vitamin D level low after resuscitation following heart failure
Concluded that the 35% decrease in vitamin D was due to increase in amount of blood, not because the body was using vitamin D.

Acute fluid shifts influence the assessment of serum vitamin D status in critically ill patients.

Crit Care. 2010;14(6):R216. Epub 2010 Nov 26.
Krishnan A, Ochola J, Mundy J, Jones M, Kruger P, Duncan E, Venkatesh B.
Intensive Care Unit, Princess Alexandra Hospital, University of Queensland, Ipswich Road, Woolloongabba, QLD 4102, Australia. Anand_Krishnan at health.qld.gov.au.

ABSTRACT : INTRODUCTION : Recent reports have highlighted the prevalence of vitamin D deficiency and suggested an association with excess mortality in critically ill patients. Serum vitamin D concentrations in these studies were measured following resuscitation. It is unclear whether aggressive fluid resuscitation independently influences serum vitamin D. METHODS : Nineteen patients undergoing cardiopulmonary bypass were studied. Serum 25(OH)D3, 1?,25(OH)2D3, parathyroid hormone, C-reactive protein (CRP), and ionised calcium were measured at five defined timepoints: T1 - baseline, T2 - 5 minutes after onset of cardiopulmonary bypass (CPB) (time of maximal fluid effect), T3 - on return to the intensive care unit, T4 - 24 hrs after surgery and T5 - 5 days after surgery. Linear mixed models were used to compare measures at T2-T5 with baseline measures.

RESULTS : Acute fluid loading resulted in a 35% reduction in 25(OH)D3 (59 ± 16 to 38 ± 14 nmol/L, P < 0.0001) and a 45% reduction in 1?,25(OH)2D3 (99 ± 40 to 54 ± 22 pmol/L P < 0.0001) and i(Ca) (P < 0.01), with elevation in parathyroid hormone (P < 0.0001). Serum 25(OH)D3 returned to baseline only at T5 while 1?,25(OH)2D3 demonstrated an overshoot above baseline at T5 (P < 0.0001). There was a delayed rise in CRP at T4 and T5; this was not associated with a reduction in vitamin D levels at these time points.

CONCLUSIONS : Hemodilution significantly lowers serum 25(OH)D3 and 1?,25(OH)2D3, which may take up to 24 hours to resolve. Moreover, delayed overshoot of 1?,25(OH)2D3 needs consideration. We urge caution in interpreting serum vitamin D in critically ill patients in the context of major resuscitation, and would advocate repeating the measurement once the effects of the resuscitation have abated.
PMID: 21110839

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