Loading...
 
Translate Register Log In Login with facebookLogin and Register

Intensive Care (ICU) helped by Vitamin D – review of past and on-going studies – Dec 2018

Vitamin D and critical illness: what endocrinology can learn from intensive care and vice versa.

Endocr Connect. 2018 Dec 1;7(12):R304-R315. doi: 10.1530/EC-18-0184.
Amrein K1,2, Papinutti A3, Mathew E3,4, Vila G5, Parekh D6.

VitaminDWiki

Important ICU Considerations - by VitaminDWiki

  1. Start the Vitamin Dosing before the surgery if at all possible
    • Outcomes will be far better
  2. Add vitamin D if < 30 ng, not just < 12 ng
    • Surgery/trauma reduces the vitamin D levels in a few days
  3. Use a gut-compatible form of vitamin D if there is a chance that the patient has poor gut (~30% of patients)
  4. Allocate some of the Vitamin D loading dose to very fast response type - inside the cheek or under the tongue
    • raises vitamin D levels in ~3 hours instead of 12 hours
  5. Obese need larger doses to get to the same blood level
  6. Test vitamin D levels about a week after surgery/ICU - and replenish if < 30 ng
  7. Many studies have found that Omega-3 helps as well
  8. Avoid use of injection (too slow) and Vitamin D2 - poor response
  9. Consider adding something to increase amount of vitamin D which acutally gets to tissue
    • Resveratrol, etc increase the activation of the Vitamin D Receptor

 Download the PDF from VitaminDWiki
Large ongoing ICU trial starts with 540,000 IU
Image

The prevalence of vitamin D deficiency in intensive care units ranges typically between 40 and 70%. There are many reasons for being or becoming deficient in the ICU. Hepatic, parathyroid and renal dysfunction additionally increases the risk for developing vitamin D deficiency. Moreover, therapeutic interventions like fluid resuscitation, dialysis, surgery, extracorporeal membrane oxygenation, cardiopulmonary bypass and plasma exchange may significantly reduce vitamin D levels. Many observational studies have consistently shown an association between low vitamin D levels and poor clinical outcomes in critically ill adults and children, including excess mortality and morbidity such as acute kidney injury, acute respiratory failure, duration of mechanical ventilation and sepsis. It is biologically plausible that vitamin D deficiency is an important and modifiable contributor to poor prognosis during and after critical illness. Although vitamin D supplementation is inexpensive, simple and has an excellent safety profile, testing for and treating vitamin D deficiency is currently not routinely performed. Overall, less than 800 patients have been included in RCTs worldwide, but the available data suggest that high-dose vitamin D supplementation could be beneficial. Two large RCTs in Europe and the United States, together aiming to recruit >5000 patients, have started in 2017, and will greatly improve our knowledge in this field. This review aims to summarize current knowledge in this interdisciplinary topic and give an outlook on its highly dynamic future.

Created by admin. Last Modification: Wednesday September 25, 2019 07:56:36 GMT-0000 by admin. (Version 7)

Attached files

ID Name Comment Uploaded Size Downloads
12132 ICU RCT.jpg admin 14 Jun, 2019 20:27 77.26 Kb 46
12131 ICU RCT.pdf PDF 2018 admin 14 Jun, 2019 20:26 570.98 Kb 35
See any problem with this page? Report it (FINALLY WORKS)