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18 fewer hospital days if given 500,000 IU of vitamin D while ventilated in ICU – RCT June 2016

High dose vitamin D administration in ventilated intensive care unit patients: A pilot double blind randomized control trial

Journal of Clinical & Translational Endocrinology, Available online 5 May 2016, doi:10.1016/j.jcte.2016.04.004
Jenny E. Han, MD, MSc1, 2, a, jehan2 at emory.edu, Jennifer L. Jones, PhD, RD3, a, Vin Tangpricha, MD, PhD3, 6, Mona A. Brown, MSN, RN1, Lou Ann S. Brown, PhD4, Li Hao, MD3, Gautam Hebbar, MBBS, MPH3, Moon Jeong Lee3, Shuling Liu, PhD5, Thomas R. Ziegler, MD3, Greg S. Martin, MD,MSc1, 2
1 Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA
2 Emory Critical Care Center, Emory University, Atlanta, GA
3 Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University, Atlanta, GA
4 Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Emory University, Atlanta, GA
5 Rollins School of Public Health, Emory University, Atlanta, GA
6 Atlanta VA Medical Center, Decatur, GA

VitaminDWiki Summary

One or two capsules of 50,000 IU of vitamin D daily for 5 days (Bio-Tech)

Vitamin D levelsHospital Days
Placebo21 nanograms 36 days
250,000 IU 46 nanograms25 days
500,000 IU55 nanograms18 days

VitaminDWiki suspects even fewer days if had

  • Extended the time beyond just 5 days
  • Added cofactors such as Magnesium and Omega-3
  • Increased the dose for those who were obese
  • Increased the dose for those who were very vitamin D deficient

See also VitaminDWiki

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: 137 studies at VitaminDWiki

The items which are in both Intervention and Trauma/Surgery are listed here

• First double blind RCT of vitamin D therapy in mechanically ventilated patients
• Treatment with placebo, 250000 IU or 500000 IU enteral vitamin D3 was well tolerated
• Significant increase in plasma 25(OH)D from baseline to day 7
• Significant decrease in hospital length of stay for vitamin D3 treated subjects
• No change in plasma LL-37 according to treatment group
Response to 250K, 500 K loading doses  VitDWiki page 7512

Background: There is a high prevalence of vitamin D deficiency in the critically ill patient population. Several intensive care unit studies have demonstrated an association between vitamin D deficiency [25-hydroxyvitamin D (25(OH)D) < 20 ng/mL] and increased hospital length of stay (LOS), readmission rate, sepsis and mortality.

Material and Methods: Pilot, double blind randomized control trial conducted on mechanically ventilated adult ICU patients. Subjects were administered either placebo, 50,000 IU vitamin D3 or 100,000 IU vitamin D3 daily for 5 consecutive days enterally (total vitamin D3 dose = 250,000 IU or 500,000 IU, respectively). The primary outcome was plasma 25(OH)D concentration 7 days after oral administration of study drug. Secondary outcomes were plasma levels of the antimicrobial peptide cathelicidin (LL37), hospital LOS, SOFA score, duration of mechanical ventilation, hospital mortality, mortality at 12 weeks, and hospital acquired infection.

Results: A total of 31 subjects were enrolled with 13 (43%) being vitamin D deficient at entry (25(OH)D levels < 20 ng/mL). The 250,000 IU and 500,000 IU vitamin D3 regimens each resulted in a significant increase in mean plasma 25(OH)D concentrations from baseline to day 7; values rose to 45.7±19.6 ng/mL and 55.2 ± 14.4 ng/mL, respectively, compared to essentially no change in the placebo group (21±11.2 ng/mL), p<0.001. There was a significant decrease in hospital length of stay over time in the 250,000 IU and the 500,000 IU vitamin D3 group, compared to the placebo group (25 ± 14 and 18 ± 11 days compared to 36 ± 19 days, respectively; p=0.03). There was no statically significant change in plasma LL-37 concentrations or other clinical outcomes by group over time.

Conclusions: In this pilot study, high-dose vitamin D3 safely increased plasma 25(OH)D concentrations into the sufficient range and was associated with decreased hospital length of stay without altering other clinical outcomes.

www.clinicaltrials.gov (NCT01372995)

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18 fewer hospital days if given 500,000 IU of vitamin D while ventilated in ICU – RCT June 2016        

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