Table of contents
- See also VitaminDWiki
- Potential ways Vitamin D can help burns - April 2019
- Burn Centers typically still do not test vitamin D levels- survey – March 2019
- Burns with higher vitamin D have fewer problems - Feb 2019
- Nearly all burn patients have low Vitamin D levels - May 2018
- 50% fracture admissions occurred within 7 years of burn admission - Sept 2017
- Burns with low vitamin D associated with more days in ICU and hospital – Jan 2017
- Bone fractures after a burn - none if vitamin D, 6 if no vitamin D – RCT May 2015
- Vitamin D status after a high dose of cholecalciferol in healthy and burn subjects
- Quarterly Vitamin D injections (200,000 IU) helped muscles in burn patients - March 2015
- Both vitamins D3 and D2 (100 IU/kg) provided some help to Critically Ill Pediatric Burn Patient - June 2015
- 97% of pediactric burn patients had low vitamin D - Feb 2016
- Pain 6 months after thermal burn and skin autography asociated with low vitamin D and low Omega-3 - March 2018
- Burned in factory explosion: 8X less likely to get infected if treated with Magnesium and Vitamins such as B12 - RCT Nov 2018
- The effect of vitamin D on different human cells, with emphasis on burns and ICU – April 2018
- Hypothesis: Extensive burns reduce vitamin D, which increase bone loss – Nov 2012 Klein
- Burned skin produces only about 25 percent as much vitamin D – March 2012 Klein
- People with old burns improved muscle strength with 2200 IU average vitamin D – RCT Sept 2014
many of same authors as the study on this page
- Reasons for low response to vitamin D
- Quarterly vitamin D injections 2 years after burns did not help bones – March 2015 same primary author
- 92 percent of Burn patients had low vitamin D, 600 IU did not help – Aug 2014 far too little
- Severely burned children recovered muscle capability much faster with daily 1000 IU of vitamin D – RCT March 2017
- Can burn pain be relieved by 4 g of Omega-3 and 2,000 IU of vitamin D – RCT due 2021
- Burns - will 200,000 IU of vitamin D decrease hospital stay - RCT 2021
Vitamin D status and its influence on outcomes following major burn injury and critical illness
Burns & Trauma 20186:11 https://doi.org/10.1186/s41038-018-0113-4
Vitamin D deficiency is common among the general population. It is also observed in up to 76% of critically ill patients. Despite the high prevalence of hypovitaminosis D in critical illness, vitamin D is often overlooked by medical staff as the clinical implications and consequences of vitamin D deficiency in acute contexts remain to be fully understood. Vitamin D has a broad range of pleotropic effects on various processes and systems including the immune-inflammatory response. 1α,25-dihydroxyvitamin D (1,25(OH)2D), has been shown to promote a tolerogenic immune response limiting deleterious inflammatory effects, modulation of the innate immune system, and enhancement of anti-microbial peptides. Vitamin D deficiency is frequently observed in critically ill patients and has been related to extrinsic causes (i.e., limited sunlight exposure), magnitude of injury/illness, or the treatment started by medical doctors including fluid resuscitation. Low levels of vitamin D in critically ill patients have been associated with sepsis, organ failure, and mortality. Despite this, there are subpopulations of critical illness, such as burn patients, where the literature regarding vitamin D status and its influence on outcomes remain insufficient. Thermal injury results in damage to both burned and non-burned tissues, as well as induces an exaggerated and persistent immune-inflammatory and hypermetabolic response. In this review, we propose potential mechanisms in which burn injury affects the vitamin D status and summarizes current literature investigating the influence of vitamin D status on outcomes. In addition, we reviewed the literature and trials investigating vitamin D supplementation in critically ill patients and discuss the therapeutic potential of vitamin D supplementation in burn and critically ill patients. We also highlight current limitations of studies that have investigated vitamin D status and supplementation in critical illness. Thermal injury influences vitamin D status. More studies investigating vitamin D depletion in burn patients and its influence on prognosis, via standardized methodology, are required to reach definitive conclusions and influence clinical practice
No such attachment on this page
234 A Multi-center Survey of Vitamin D Monitoring and Supplementation in Patients with Thermal Injuries
Journal of Burn Care & Research, Vol 40, Issue Supt_1, 9 March 2019, Pages S97–S98, https://doi.org/10.1093/jbcr/irz013.161
S Zavala, PharmD, BCPS D M Hill, PharmD, BCPS
A total of 21 responses were received. Eight respondents (38.1%) routinely check 25-hydroxyvitamin D concentrations. Two centers check concentrations on admission, two centers check within 48 hours of admission, three centers check within one week of admission. One center specifically monitors concentrations only for patients with a > 20% total body surface area (TBSA) burned. Five centers report rechecking concentrations within weeks to months of the initial level,. Four centers primarily use ergocalciferol, three use cholecalciferol, and one has no preference. Dosing varied greatly between sites. Two respondents reported adjusting dose based on degree of deficiency and admission concentration. One respondent reported a dosing regimen adjusted to age and percent TBSA burned. Thirteen respondents (61.9%) do not routinely check vitamin D concentrations, but may if patients are healing poorly, malnourished, or per nutritionist or nephrologist recommendations. One of the burn centers, who does not routinely monitor concentrations, supplements all burn patients who have ≥ 15% TBSA with cholecalciferol 2000 units daily. Barriers to routinely monitoring vitamin D concentrations cited were cost, inability to analyze in-house, and lack of evidential recommendations for monitoring and supplementing patients with thermal injuries.
The current practice of monitoring and supplementing vitamin D varies widely across burn centers. Future studies using consistent monitoring and dosing should be conducted to determine the clinical benefit of adequate vitamin D levels in burn patients.
The association between postburn vitamin D deficiency and the biomechanical properties of hypertrophic scars.
J Burn Care Res. 2019 Feb 26. pii: irz028. doi: 10.1093/jbcr/irz028.
Cho YS1, Seo CH1, Joo SY1, Song J2, Cha E2, Ohn SH2.
Fibroblasts, keratinocytes, mast cells, and other cells participate in hypertrophic scar formation and express the vitamin D receptor. We investigated the association between vitamin D deficiency and the biomechanical properties of hypertrophic burn scars. This cross-sectional study analyzed 486 participants enrolled from May 1, 2013 to April 30, 2017. When complete wound healing was agreed with by the two opinions, blood sampling and scar evaluation were performed. The value of melanin and erythema, trans-epidermal water loss (TEWL), and scar distensibility and elasticity were measured using pigment- and TEWL-measuring devices and a suction skin elasticity meter. 25(OH) vitamin D deficiency was defined as plasma level of < 20 ng/mL.
The vitamin D-deficient patients had significantly higher mean values of scar melanin and TEWL (P = 0.032, P = 0.007), whereas scar erythema level was similar. They also showed significantly lower values of
- Uf (final distensibility; P < 0.001),
- Ua/Uf (gross elasticity; P < 0.001) and
- Ur/Uf (biological elasticity; P = 0.014),
and higher value of Uv/Ue (viscoelasticity or potency against interstitial fluid shift; P = 0.016).
In multiple linear regression analysis, Uf, Ua/Uf, Uv/Ue, and Ur/Uf were significantly affected by 25(OH)-vitamin D level in deficient patients (Uf, P = 0.017; Ua/Uf, P = 0.045; Uv/Ue, P = 0.024; Ur/Uf, P = 0.021).
Our results demonstrated that vitamin D deficiency was significantly related to
- increased pigmentation,
- decreased skin barrier function,
- low scar distensibility and elasticity, and
- slow interstitial fluid movement in burn patients.
"Fracture admission rates twice as high for burn cohort than Australian population."
Vitamin D in burn-injured patients
Burns Journal DOI: https://doi.org/10.1016/j.burns.2018.04.015
Fracture admissions after burns: A retrospective longitudinal study
Burn Journal https://doi.org/10.1016/j.burns.2017.02.014
Low Vitamin D Level on Admission for Burn Injury Is Associated With Increased Length of Stay.
J Burn Care Res. 2017 Jan/Feb;38(1):e8-e13. doi: 10.1097/BCR.0000000000000445.
Blay B1, Thomas S, Coffey R, Jones L, Murphy CV.
Currently, there have been few studies that have evaluated the incidence of vitamin D deficiency in adult burn patients or correlated vitamin D levels with burn-related outcomes. The primary objective of the study was to identify the incidence of vitamin D deficiency and insufficiency in an adult burn population. The secondary objective was to determine the impact of vitamin D deficiency and insufficiency on clinical outcomes in burn care. A single-center, retrospective, and observational cohort analysis of adult patients admitted for initial management of burn injury, who had a 25-hydroxyvitamin D (25D) level measured on admission, was performed. Patients were categorized as vitamin D deficient (25D <10 ng/ml), insufficient (10-29 ng/ml), or sufficient (30-100 ng/ml) based on admission measurements. Clinical outcomes including complications, intensive care unit (ICU) and hospital length of stay (LOS), and survival were compared between patients with vitamin D deficiency/insufficiency and patients with vitamin D sufficiency. Three-hundred and eighteen patients were eligible for evaluation. Admission 25D level correlated with deficiency in 46 patients (14.5%), insufficiency in 207 (65.1%), and normal in 65 (20.4%). Patients with vitamin D deficiency or insufficiency experienced higher rates of complications and longer ICU and hospital LOS compared with those with normal vitamin D levels. A large proportion of patients with burn injury presented with vitamin D insufficiency and deficiency which was associated with poor outcomes, including prolonged ICU and hospital LOS. Additional studies are needed to further describe the relationship between vitamin D status and clinical outcomes.
PMID: 27679960 DOI: 10.1097/BCR.0000000000000445  Download the PDF from Sci-Hub via VitaminDWiki
Burns, DOI: http://dx.doi.org/10.1016/j.burns.2014.11.011
Anne-Françoise Rousseau afrousseau at chu.ulg.ac.be , Pierre Damas, Didier Ledoux, Pierre Lukas, Agnès Carlisi, Caroline Le Goff, Romy Gadisseur, Etienne Cavalier
Single dose of 100,000 IU of Vitamin D3, test again 7 days later
| highest |
|Burn||11 ng||-37% |
- Levels of 25OH-D at hospital admission following burn were straightaway lower than our healthy subjects.
- Efficacy of 100,000 IU cholecalciferol to raise 25OH-D levels (and free 25OH-D levels) was quite uncertain, lower or even zero, in burn patients when compared to healthy subjects.
- Higher cholecalciferol doses than general recommendations should probably be considered during acute burn care.
- Interest of free 25OH-D is still questionable.
Burn patients are at risk of vitamin D (VD) deficiency and may benefit from its pleiotropic effects as soon as acute phase. Aim of this observational study was to assess effects of a cholecalciferol (VD3) bolus on VD status in adult burn patients (Group B, GB) after admission, compared to healthy subjects (Group H, GH).
Both groups received an oral dose of 100,000 IU VD3. Blood samples were collected before (D0) and 7 days (D7) after bolus to measure 250H-D, 1,25(OH)2-D, parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23). Albumin (ALB) and VD binding protein (DBP) were measured and used to calculate free 25OH-D level. Data were expressed as median (min–max) or proportions.
A total of 49 subjects were included: 29 in GH and 20 in GB. At D0, prevalence of VD deficiency was higher in GB: 25OH-D was 21.5 (10.1–46.3) ng/ml in GH vs 11 (1.8–31.4) ng/ml in GB. DBP and ALB were lower in GB. At D7, DBP was stable in both groups while ALB decreased in GB. 25OH-D increased by 66.6 (13.5–260.3)% in GH. In GB, changes in 25OH-D extended from −36.7% to 333.3% with a median increase of 33.1%. Similar changes were observed in each group for free 25OH-D. High FGF23 levels were observed in GB.
This study highlighted the differences in VD status and in response to a high dose VD3 in burn patients when compared to healthy patients. Pitfalls in VD status assessment are numerous during acute burn care: 25OH-D measurement needs cautious interpretation and interest of free 25OH-D is still questionable. They should not prevent burn patients to receive VD supplements during acute care. Higher doses than general recommendations should probably be considered.
Effects of cholecalciferol supplementation and optimized calcium intakes on vitamin D status, muscle strength and bone health: a one-year pilot randomized controlled trial in adults with severe burns.
Burns. 2015 Mar;41(2):317-25. doi: 10.1016/j.burns.2014.07.005. Epub 2014 Sep 16.
Rousseau AF1, Foidart-Desalle M2, Ledoux D3, Remy C4, Croisier JL5, Damas P3, Cavalier E6.
1Burn Centre and General Intensive Care Department, University of Liège, University Hospital, Liège, Belgium. Electronic address: afrousseau at chu.ulg.ac.be.
2Physical Medicine and Sport Traumatology Service, University of Liège, University Hospital, Liège, Belgium.
3Burn Centre and General Intensive Care Department, University of Liège, University Hospital, Liège, Belgium.
4Burn Centre and General Intensive Care Department, University of Liège, University Hospital, Liège, Belgium; Motility Science Department, University of Liège, Liège, Belgium.
5Motility Science Department, University of Liège, Liège, Belgium.
6Clinical Chemistry Department, University of Liège, University Hospital, Liège, Belgium.
Burn patients are at risk of hypovitaminosis D and osteopenia or sarcopenia. Vitamin D pleiotropic effects may influence bone and muscle health. The aim of this pilot study was to assess effects of a cholecalciferol (VD3) supplementation and an optimized calcium (Ca) regimen on vitamin D (VD) status, bone and muscle health during sequelar stage of burn injury.
Monocentric randomized controlled trial.
Fifteen adults with thermal burns dating from 2 to 5 years were randomized into two groups. For 12 months, they either received a quarterly IM injection of 200,000IU VD3 and daily oral Ca (Group D) or placebo (Group P). VD status and bone remodeling markers were assessed every 3 months. Knee muscle strength and bone mineral density were, respectively, assessed using isokinetic dynamometry and dual X-ray absorptiometry at initiation (M0) and completion (M12) of the protocol.
Of all the patients, 66% presented with VD deficiency and 53% (with 3 men <40y) were considered osteopenic at inclusion. After one year, calcidiol levels significantly increased in Group D to reach 40 (37-61)ng/ml. No significant change in bone health was observed in both groups while Group D significantly improved quadriceps strength when tested at high velocity.
This VD3 supplementation was safe and efficient to correct hypovitaminosis D in burn adults. When combined with optimized Ca intakes, it demonstrated positive effects on muscle health but not on bone health. A high prevalence of hypovitaminosis D and osteopenia in these patients, as well as their wide range of muscle performances, seem to be worrying when considering rehabilitation and quality of life.
Note: 200,000 IU over 90 days is an average of only 2200 IU daily - not very much
Both vitamins D3 and D2 (100 IU/kg) provided some help to Critically Ill Pediatric Burn Patient - June 2015
Clinical Trial of Vitamin D2 vs D3 Supplementation in Critically Ill Pediatric Burn Patients
Michele M. Gottschlich, PhD, RD, CSP1,2,3
Theresa Mayes, RD, CSP, CCRC2,4
Jane Khoury, PhD4
Richard J. Kagan, MD3,5
1Department of Research, Shriners Hospitals for Children, Cincinnati, Ohio
2Department of Nutrition, Shriners Hospitals for Children, Cincinnati, Ohio
3Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
4Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
5Department of Surgery, Shriners Hospitals for Children, Cincinnati, Ohio
Michele M. Gottschlich, PhD, RD, CSP, Shriners Hospitals for Children, 3229 Burnet Ave, Cincinnati, OH 45229, USA. Email: mgottschlich at shrinenet.org
Background: Hypovitaminosis D exists postburn. However, evidence-based guidelines for vitamin D repletion are unknown. This investigation examined differences between D2 and D3 supplementation on outcome in children with burn injuries.
Methods: Fifty patients with total body surface area burn of 55.7% ± 2.6% and full-thickness injury of 40.8% ± 3.8% were enrolled, ranging in age from 0.7–18.4 years. All participants received multivitamin supplementation per standardized clinical protocol. In addition, 100 IU/kg D2, D3, or placebo was administered daily during hospitalization using a randomized, double-blinded study design. Assay of total 25-hydroxyvitamin D (D25), 1,25-dihydroxyvitamin D (D1,25), 25-hydroxyvitamin D2 (25-OH-D2), 25-hydroxyvitamin D3 (25-OH-D3), and parathyroid hormone (PTH) was performed at 4 preplanned time intervals (baseline, midpoint, discharge, and 1 year postburn). Differences in vitamin D status were compared over time and at each specific study interval.
Results: There were no significant differences in serum vitamin D levels between groups, but >10% of patients had low D25 at discharge, and percent deficiency worsened by the 1-year follow up for the
- placebo (75%),
- D2 (56%), and
- D3 (25%) groups. (note: D3 lasted much longer)
There were no statistical differences in PTH or clinical outcomes between treatment groups, although vitamin D supplementation demonstrated nonsignificant but clinically relevant decreases in exogenous insulin requirements, sepsis, and scar formation.
Conclusions: The high incidence of low serum D25 levels 1 year following serious thermal injury indicates prolonged compromise. Continued treatment with vitamin D3 beyond the acute phase postburn is recommended to counteract the trajectory of abnormal serum levels and associated morbidity.
New research calls for vitamin D supplementation in critically ill pediatric burn patients Medical Express Review of the study
Serum 25-Hydroxyvitamin D Levels in Pediatric Burn Patients.
Trauma Mon. 2016 Feb 6;21(1):e30905. doi: 10.5812/traumamon.30905. eCollection 2016.
Sobouti B1, Riahi A2, Fallah S3, Ebrahimi M1, Shafiee Sabet A4, Ghavami Y5.
1Burn Research Center, Shahid Motahari Burns Hospital, Iran University of Medical Sciences, Tehran, IR Iran.
2Department of Pediatric Infectious Diseases, Ali-Asghar Children Hospital, Iran University of Medical Sciences, Tehran, IR Iran.
3Department of Neonatology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
4Medical Student Research Committee (MSRC), School of Medicine, Iran University of Medical Sciences, Tehran, IR Iran.
5Burn Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Previous studies have implicated the important and active role of vitamin D in the immune system.
The aim of this study was to evaluate serum levels of 25-hydroxyvitamin D in children with burn injuries.
MATERIALS AND METHODS:
In this cross-sectional study, 118 patients with various degrees of burn injuries were enrolled. A checklist consisting of demographic data, total body surface area (TBSA) affected by burn, degree of burn, serum level of 25(OH)D, total protein, albumin, electrolytes, and parathyroid hormone was recorded for each patient.
Sixty-eight (57.6%) males and 50 (42.4%) females with a mean age of 4.04 years (SD = 3.04) were evaluated. The mean level of 25(OH)D was 14.58 ng/mL (SD = 6.94). Levels of 25(OH)D in four (3.39%) cases were higher than 30 ng/mL, while 95 (81.35%) cases had levels lower than 20 ng/mL, and 19 (16.10%) cases had levels of 21 - 30 ng/mL.
The level of 25(OH)D was below recommended levels in 96.61% of cases, while 81.34% had vitamin D deficiency and 16.1% had insufficiency. We found a significant correlation between vitamin 25(OH)D and total protein, albumin, and total and ionized calcium (P < 0.001). There was also a significant negative correlation between 25(OH)D and TBSA affected by burn (P = 0.001).
The levels of 25(OH)D in children suffering from severe burns were low. Supplementation might be useful in patients with very low levels of serum vitamin D.
Pain 6 months after thermal burn and skin autography asociated with low vitamin D and low Omega-3 - March 2018
Vitamin D and N-3 polyunsaturated fatty acid levels predict chronic pain following major thermal burn injury
- "Major Thermal Burn Injury (MThBI) is a significant public health problem in which 50,000 individuals are hospitalized annually in the US. Chronic pain is common following MThBI affecting up to 60% of survivors. There are currently few treatment options to reduce chronic pain and improve mental and physical function following MThBI. Accumulating evidence suggests Vitamin D and n-3 polyunsaturated fatty acids (PUFAs, commonly found in fish oil) reduce symptom burden in other pain conditions. Therefore, we hypothesize low levels of n-3 PUFAs and Vitamin D predict greater chronic pain severity after MThBI."
DOI: https://doi.org/10.1016/j.jpain.2017.12.243. Abstract only
Burned in factory explosion: 8X less likely to get infected if treated with Magnesium and Vitamins such as B12 - RCT Nov 2018
Additional Vitamin and Mineral Support for Patients with Severe Burns: A Nationwide Experience from a Catastrophic Color-Dust Explosion Event in Taiwan
Nutrients 2018, 10(11), 1782; https://doi.org/10.3390/nu10111782 (registering DOI)
Li-Ru Chen 1,2,†, Bing-Shiang Yang 2,†, Chih-Ning Chang 1, Chia-Meng Yu 3 and Kuo-Hu Chen 4,5,* OrcID
Major burn injuries, which encompass ≥20% of the total body surface area (TBSA), are the most severe form of trauma because of the stress response they provoke, which includes hypermetabolism, muscle wasting, and stress-induced diabetes. In 2015, a color-dust explosion disaster occurred in the Formosa Fun Coast of Taiwan and injured 499 people, who were transferred via a nationwide emergency delivery system. Some recommendations are currently available regarding vitamin and mineral support for wound healing and recovery in severe burns, but there is a lack of evidence to confirm the benefits. Thus, the current study aimed to investigate the effects of additional vitamin and mineral support for patients with severe burn injuries. Sixty-one hospitalized individuals with major burns (full thickness and ≥20% TBSA) were classified into the supplement (n = 30) and control (n = 31) groups, according to whether they received supplementation with additional vitamins, calcium, and magnesium. There were significant differences between the supplement and control groups in the
- incidence of wound infection (30.0% vs. 77.4%, p < 0.001),
- sepsis (13.3% vs. 41.9%, p = 0.021), and
- hospitalization days (51.80 vs. 76.81, p = 0.025).
After adjustment, logistic regression analysis revealed that, compared to those in the control group, patients in the supplement group had a
- lower risk for wound infection (OR 0.11; 95% CI 0.03–0.43; p = 0.002) and
- sepsis (OR 0.09; 95% CI 0.01–0.61; p = 0.014).
Supplementation of multiple vitamins, calcium, and magnesium reduced the risk of wound infection and sepsis, shortened the time of hospitalization, and can be considered for use in major burns.
Download the PDF from VitaminDWiki
During the first two weeks of hospitalization, daily vitamins were administered to those in the supplement group, including
vitamin A 6600 IU, vitamin B1 (thiamine) 100 mg, vitamin B6 (pyridoxine)
200 mg, vitamin B12 2000 mcg, vitamin C (ascorbic acid) 100 mg, vitamin D 0.01 mg (400 IU), and
vitamin E (dl-α-tocopheryl acetate) 20 mg. Mineral supplementation with calcium and magnesium was
provided by the administration of calcium chloride 2%, 20 mL/amp, and magnesium sulfate injection
10%, 20 mL/amp, adjusted according to serum calcium and magnesium levels after biochemistry examinations