Muscle weakness in intensive care patients: Initial manifestation of vitamin D deficiency

Proximal muscle weakness is a common presentation in paediatric-orthopaedic clinics and is frequently paired with a vitamin D deficiency diagnosis. Recently, side effects of the extensive use of antiepileptic and antipsychotic drugs such as sodium valproate in childhood disorders are being documented. Sodium valproate causes a time-dependent, drug-induced proximal myopathy. We report a 13-year-old female patient who presented at the Orthopaedic Outpatient Department at Lady Hardinge Medical College, New Delhi, India, in 2019 with an abnormal gait. The patient was taking a combination therapy of sodium valproate, risperidone and trihexyphenidyl for absence seizures and a mood disorder. Following clinical investigations, the patient was diagnosed with proximal myopathy. As a result of elevated serum alkaline phosphatase and creatine kinase myocardial band levels, sodium valproate was replaced with ethosuximide and a carnitine supplementation was prescribed. The patient fully recovered and regained full mobility. Proximal myopathy had been incorrectly managed and assumed to be caused by a vitamin D deficiency.Keywords: Muscle Weakness; Carnitine; Myopathy; Valproic Acid; Vitamin D Deficiency; Gait; Case Report; India.

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Prevalence and Correction of 25(OH) Vitamin D Deficiency in Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686080502500411 ◽

2005 ◽

Vol 25 (4) ◽

pp. 362-366 ◽

Cited By ~ 61

Author(s):

Nirav Shah ◽

Judith Bernardini ◽

Beth Piraino

Keyword(s):

Vitamin D ◽

Peritoneal Dialysis ◽

Calcium Phosphate ◽

Vitamin D Deficiency ◽

Muscle Weakness ◽

Serum Calcium ◽

Bone Pain ◽

Vitamin D Levels ◽

Before And After ◽

25 Oh Vitamin D

Background Peritoneal dialysis (PD) patients are at risk for 25(OH) vitamin D deficiency due to effluent loss in addition to traditional risk factors. Objectives To measure 25(OH) vitamin D deficiency in prevalent PD patients, to evaluate a replacement dose, and to determine the effects of correction. Methods 25(OH) vitamin D levels were drawn on prevalent PD patients. Patients deficient in 25(OH) vitamin D were given ergocalciferol, 50 000 IU orally once per week for 4 weeks. Patients scored muscle weakness, bone pain, and fatigue on a scale of 0 (none) to 5 (severe). Serum calcium, phosphate, parathyroid hormone (PTH), and 25(OH) vitamin D, and 1,25(OH)2 vitamin D levels were obtained before and after treatment. Results 25(OH) vitamin D levels were measured in 29 PD patients. Deficiency (<15 ng/mL) was found in 28/29 (97%); 25/29 (86%) had undetectable levels (<7 ng/mL). One course of ergocalciferol corrected the deficiency in all but 1 patient, who required a second course. Scores for muscle weakness and bone pain fell from pre- to posttreatment ( p < 0.001). 1,25(OH)2 vitamin D levels rose post ergocalciferol (from 20 to 26 pg/mL, n = 20, p = 0.09). Serum calcium, phosphate, and PTH levels did not change with ergocalciferol. Conclusions Most PD patients had marked 25(OH) vitamin D deficiency, which was readily and safely corrected with one course of 50000 IU ergocalciferol, having no effect on serum calcium, phosphorus, or PTH, but complaints of muscle weakness and bone pain decreased. A prospective, placebo-controlled double-blinded study is needed to determine whether replacement of 25(OH) vitamin D is beneficial in PD patients.

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Worsening severity of vitamin D deficiency is associated with increased length of stay, surgical intensive care unit cost, and mortality rate in surgical intensive care unit patients

The American Journal of Surgery ◽

10.1016/j.amjsurg.2011.07.021 ◽

2012 ◽

Vol 204 (1) ◽

pp. 37-43 ◽

Cited By ~ 75

Author(s):

L. Ray Matthews ◽

Yusuf Ahmed ◽

Kenneth L. Wilson ◽

Diane D. Griggs ◽

Omar K. Danner

Keyword(s):

Intensive Care Unit ◽

Vitamin D ◽

Intensive Care ◽

Mortality Rate ◽

Length Of Stay ◽

Vitamin D Deficiency ◽

Unit Cost ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care ◽

Intensive Care Unit Cost

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Epidemiology of the association between serum 25-hydroxyvitamin D levels and musculoskeletal conditions among elderly individuals: a literature review

Journal of PHYSIOLOGICAL ANTHROPOLOGY ◽

10.1186/s40101-020-00249-3 ◽

2020 ◽

Vol 39 (1) ◽

Author(s):

Kazuhiko Arima ◽

Satoshi Mizukami ◽

Takayuki Nishimura ◽

Yoshihito Tomita ◽

Hiroki Nakashima ◽

...

Keyword(s):

Older Adults ◽

Vitamin D ◽

Risk Factor ◽

Vitamin D Deficiency ◽

Muscle Weakness ◽

Elderly Individuals ◽

Musculoskeletal Conditions ◽

Hydroxyvitamin D ◽

25 Hydroxyvitamin D ◽

Osteoporosis Fracture

Abstract Background Vitamin D deficiency is associated with osteoporosis, fracture, muscle weakness, falls, and osteoarthritis in adults. Elderly individuals are more likely to present with poor musculoskeletal conditions. Recently, several epidemiological studies have assessed the correlation between serum 25-hydroxyvitamin D (25(OH)D) levels and musculoskeletal conditions in elderly individuals. Main text Osteoporosis is a skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture. Numerous studies have shown a positive association between serum 25(OH)D levels and bone mineral density. Only a few studies have reported an association between serum 25(OH)D levels and quantitative ultrasound (QUS) parameters. Low serum 25(OH)D level may be a risk factor for hip fracture. However, data on the association between vitamin D deficiency and the incidence of non-hip fracture are contrasting. Falls are a major cause of mortality and morbidity in older adults. Several prospective population-based cohort studies have shown that low 25(OH)D levels are associated with an increased risk of falls. Reduced muscle strength and physical performance are risk factors for adverse events, including disability, institutionalization, and mortality. The role of vitamin D in musculoskeletal functionality (muscle weakness and physical performance) among elderly individuals is still controversial. Osteoarthritis (OA) is the most common form of arthritis and is a leading cause of disability among older adults. Data on the association between serum 25(OH)D levels and OA are contrasting. Conclusion Some studies have shown that vitamin D deficiency may be a risk factor for poor musculoskeletal conditions, such as osteoporosis, fracture, muscle weakness, falls, and osteoarthritis in adults. However, other studies did not find an association between serum 25(OH)D levels and musculoskeletal conditions.

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