Youssef et al. make a strong case for addressing 25(OH)D concentration (vitamin D status) in hospitalized patients with infections

Dermato endocrinology Volume 4, Issue 2 April/May 2012
David McCarthy dmccarthy@RIBOMED.COM, Independent Contractor; Ofallon, IL USA

Correcting vitamin D deficiency in the outpatient setting has become commonplace and is a routine in many primary care practices. This extension into the inpatient setting is timely and logical. The benefits of vitamin D testing continue to be demonstrated.

There are several steps that health care providers can take to assure this approach is possible: # arrange for rapid processing of 25-hydroxyvitamin D [25(OH)D] and serum calcium specimens;

1. gain approval from the hospital pharmacy and therapeutics committee to stock 5,000 IU Vitamin D capsules;
2. identify key staff physicians to provide consultative expertise in the rapid repletion of Vitamin D in septic patients;
3. identify key pharmacists who can support provider and nursing education as well as patient specific therapeutic efforts;
4. identify key nurses to educate staff in the ER, ICU and ward settings;
5. consider notifying providers of Vitamin D status, if known, at the time antibiotics or anti-viral agents are ordered;
6. correlate mortality data with Vitamin D status in hospital-wide, blinded, non-judgmental communications;
7. correlate cost and length of stay data with Vitamin D status in patients with infections;
8. consider addressing Vitamin D status in patients at the time of scheduling for elective surgeries.

Capsules of 50,000 IU Vitamin D3 are available (e.g., Biotech Pharmacal) and can be given to patients with very low serum 25-hydroxyvitamin D concentrations.

Self-education is available at vitamindcouncil.com. Vitamin D conferences have been available at several sites in North America and Europe.

Having practiced as a family physician for 25 y using the standard Vitamin D dose of 400 IU and five years using Vitamin D dosing sufficient to give blood levels > 50 ng/ml (> 120 nmoles/ml), I will never return to the “inky dinky dose” again.

References 

1.. Bailey BA, Manning T, Peiris AN. Vitamin D testing patterns among six Veterans Medical Centers in the southeastern United States: links with medical costs. Mil Med 2012; 177:70-6; PMID: 22338984.
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See also VitaminDWiki

• ICU surgical patients with low vitamin D stayed longer and had more sepsis – Dec 2011
• Vitamin D might reduce sepsis
• Staph infection reduced 50 percent when have more than 30 ng of vitamin D – Aug 2011
• Septic patients vitamin D so low that small changes did not matter – June 2011
• All items in category Cost Savings with Vitamin D 158 items
• VA found less testing for vitamin D resulted in increased health costs – Jan 2012 which is Reference #1 above
• Vitamin D might reduce military costs for UC and CD – June 2011 many of the same authors
• Black veterans have worse health and low vitamin D, yet are not tested as much – June 2011 many of the same authors
• HMOs will save millions of dollars with vitamin D
• Virtually all veterans in ICU had vitamin D less than 32 ng – Jan 2011
• 3X less Multiple Sclerosis with enough vitamin D - Veterans Administration
• Hospital stay 6 days longer for nursing home residents with low vitamin D – Oct 2011
• MRSA inpatient cost 2X higher if less than 20 ng vitamin D – June 2011
• 2X more likely to get hospital infection if low vitamin D (10 ng) when enter – Oct 2013