Jenny E. Han , MD.MSc 1 , , 2 , Jennifer L. Jones , PhD, RD 3 , Mona Brown , BSN 4 , Vin Tangpricha , MD, PhD 3 , Lou Ann Brown , PhD 4 , Li Hao , MD 3 , Gautam Hebbar , MD,MPH 5 , Shuling Liu , MS 4 , Thomas R. Ziegler , MD 5 , Gregory S. Martin , MD MSc 4 ,
Publication Date: 2015
Small Random Controlled Trial
31 patients – average 21 ng Vitamin D
Vitamin D loading dose spread over 5 days
|500,000 IU||250,000 IU||0 IU|
|Length of stay||18 days||25 days||36 days|
|Vitamin D @ 14 days||62 ng||29 ng||21 ng|
Note: days and ng are correct, and different than in the submitted abstract
J.E. Han, MD.MSc, J.L. Jones, PhD, RD, M. Brown, BSN, V. Tangpricha, MD, PhD, L.A. Brown, PhD, L. Hao, MD, G. Hebbar, MD,MPH, S. Liu, MS, T.R. Ziegler, MD, G.S. Martin, MD MSc
Rationale: Immune dysfunction and nosocomial infections are important contributors to short-term and long-term survival after critical illness. Cost-effective adjunctive therapies that can be rapidly implemented to improve the host response are imperative. It is now well established that vitamin D has pleotrophic effects on immune cells by upregulation of antimicrobial peptides, (e.g. LL-37).
Methods: We completed a double blind, randomized, controlled trial to evaluate the safety and efficacy of two doses of vitamin D3 (total 250,000 IU or 500,000 IU over 5 days,) versus placebo in adult critically ill patients with respiratory failure. Our purpose was to determine whether high-dose vitamin D3 would increase plasma 25(OH)D and LL-37 levels (measured by chemiluminescence and ELISA, respectively) without adverse effects and whether this would improve clinical outcomes [hospital and ICU length of stay (LOS), ventilator days, SOFA score, hospital infection rate].
Results: 31 subjects were enrolled and completed the treatment protocol. Mean age was 62.9, 61% male, 47% Black, 42% surgical patients, 43% infection on admission, mean APACHE I I score 22.4 and mean SOFA 7.6. These were equally balanced across all groups except for race. Aggregated mean values of 25 (OH)D and LL-37 were greater with Vitamin D3 treatment. (Table 1)
Table 1. 25(OH)D and LL-37 and Clinical Outcomes Across Groups (Just top portion of the table).
- 18 fewer hospital days if given 500,000 IU of vitamin D while ventilated in ICU – RCT June 2016
later publication of this study
- Sepsis associated with low vitamin D - April 2012 Previous publication by Dr. Han
- Search VitaminDWiki for "LENGTH OF STAY" 60 items as of May 2015
- Surgical outcomes are better for higher levels of Vitamin D – systematic review May 2015
- Acute respiratory distress – 100 percent of patients were vitamin D deficient– April 2015
- ICU survival increased with vitamin D single loading dose - JAMA Sept 2014 540,000 IU - single dose
- Healthy in Seven Days- Success through vitamin D treatment – book 2014 starts with a 400,000 IU loading dose
- 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 )