24 A Retrospective Review of Vitamin D Levels and Dosing in Burn Center Patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S21-S21
Author(s):  
Sara Calder ◽  
Asia N Quan ◽  
Suzanne C Osborn ◽  
Karen J Richey ◽  
Curt Bay ◽  
...  
Keyword(s):  
Vitamin D ◽  
Retrospective Chart Review ◽  
Vitamin D Insufficiency ◽  
Infectious Complications ◽  
Vitamin D Supplementation ◽  
High Dose ◽  
Weekly Dose ◽  
Burn Patients ◽  
Increased Risk ◽  
Vitamin D Levels

Abstract Introduction The potential consequences of vitamin D insufficiency/deficiency (I/D), include increases in ICU length of stay, organ dysfunction, infectious complications, and mortality. Burn patients, in particular, may be at increased risk of vitamin D I/D due to bleeding, systemic inflammatory response syndrome, increased utilization of vitamin D by injured tissues, compromised vascular integrity, fluid shifts, and leakage of vitamin D binding protein (VDBP) and albumin. The purpose of this study is to determine the incidence of vitamin D I/D and evaluate the institutional vitamin D dosing regimen. Methods A retrospective chart review was performed of all adult patients from January 1, 2018 through December 31, 2019 who received cholecalciferol and had at least one vitamin D hydroxy level during their hospitalization. Vitamin D level was drawn on admission, then weekly thereafter. Patients found to be I/D were initiated on high dose vitamin D supplementation and then adjusted based on the weekly levels. The therapeutic goal for vitamin D supplementation was set at 50 ng/ml. Results Three hundred and sixteen patients met criteria for review. Of those patients, 293 patients (93%) were vitamin D I/D. The magnitude of vitamin D deficiency was strongly positively correlated with %TBSA burn size (p< 0.001). Mean time to reach therapeutic vitamin D levels following initiation of supplementation was 19 days with an average weekly dose of 142,877 international units cholecalciferol. Many patients were discharged prior to reaching therapeutic levels. Time to reach therapeutic levels was also positively correlated with increasing burn size (p< 0.05). Conclusions Vitamin D I/D is present is over 90% of burn patients and the degree of I/D was profound. Additionally, vitamin D I/D was not easily corrected, taking almost 3 weeks to reach therapeutic levels using an aggressive supplementation regimen. Further studies documenting the clinical consequences of vitamin D I/D and development of evidence-based supplementation dosing regimens are warranted.

667 A Retrospective Review of Vitamin D Levels and Dosing in Burn Center Patients

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S178-S179
Author(s):  
Sara Calder ◽  
Asia N Quan ◽  
Suzanne Osborn ◽  
Virginia Nisbet ◽  
Karen J Richey ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Total Body Surface Area ◽  
Retrospective Chart Review ◽  
Vitamin D Supplementation ◽  
High Dose ◽  
Burn Patients ◽  
Burn Center ◽  
Increased Risk ◽  
Vitamin D Levels

Abstract Introduction The potential consequences of vitamin D insufficiency/deficiency (I/D) in critically ill patients include: increased ICU length of stay, organ dysfunction, infectious complications, and mortality. Burn patients, in particular, may be at increased risk of vitamin D I/D due to bleeding, systemic inflammatory response syndrome, increased utilization of vitamin D by injured tissues, compromised vascular integrity, fluid shifts, and leakage of vitamin D binding protein (VDBP) and albumin. The purpose of this study is to determine the incidence of vitamin D I/D and evaluate the institutional vitamin D dosing regimen. Methods A retrospective chart review was performed on all adult patients from January 1, 2018 through December 31, 2019 who received cholecalciferol and had at least one 25-hydroxy vitamin D level during their hospitalization. Vitamin D level was drawn on admission, then weekly thereafter. Patients found to be I/D were initiated on high dose vitamin D supplementation and then adjusted based on the weekly levels. The therapeutic goal for vitamin D supplementation was set at 50 ng/ml. Results Three hundred and sixteen patients met criteria for review. Of those patients, 293 patients (93%) were vitamin D I/D. The magnitude of vitamin D deficiency was strongly negatively correlated with increasing % total body surface area (TBSA) burn size (p< 0.001). Mean time to reach therapeutic vitamin D levels following initiation of supplementation was 19 days, requiring an average of 116,125 units cholecalciferol weekly. Time to reach therapeutic levels was also positively correlated with increasing burn size (p< 0.05). Many patients, however, were discharged prior to reaching therapeutic levels. Conclusions Vitamin D I/D is present in over 90% of burn center patients and the degree of I/D was profound. Additionally, vitamin D I/D was not easily corrected, taking almost 3 weeks to reach therapeutic levels using an aggressive supplementation regimen. Further studies documenting the consequences of vitamin D I/D and development of evidence-based supplementation dosing regimens are warranted. Applicability of Research to Practice This study documents common and severe vitamin D deficiency in burn patients, and difficulty in correcting this deficiency.

scholarly journals Vitamin D and Atherosclerotic Cardiovascular Disease

2019 ◽  
Vol 104 (9) ◽  
pp. 4033-4050 ◽  
Author(s):  
Thomas F Hiemstra ◽  
Kenneth Lim ◽  
Ravi Thadhani ◽  
JoAnn E Manson
Keyword(s):  
Cardiovascular Disease ◽  
Vitamin D ◽  
General Population ◽  
Vitamin D Deficiency ◽  
Randomized Trials ◽  
Cardiovascular Health ◽  
Vitamin D Supplementation ◽  
High Dose ◽  
Atherosclerotic Cardiovascular Disease ◽  
Vitamin D Levels

Abstract Context A large body of experimental and observational data has implicated vitamin D deficiency in the development of cardiovascular disease. However, evidence to support routine vitamin D supplementation to prevent or treat cardiovascular disease is lacking. Design and Results A comprehensive literature review was performed using PubMed and other literature search engines. Mounting epidemiological evidence and data from Mendelian randomization studies support a link between vitamin D deficiency and adverse cardiovascular health outcomes, but randomized trial evidence to support vitamin D supplementation is sparse. Current public health guidelines restrict vitamin D intake recommendations to the maintenance of bone health and prevention of fractures. Two recently published large trials (VITAL and ViDA) that assessed the role of moderate- to high-dose vitamin D supplementation as primary prevention for cardiovascular outcomes in the general population had null results, and previous randomized trials have also been generally negative. These findings from general population cohorts that are largely replete in vitamin D may not be applicable to chronic kidney disease (CKD) populations, in which the use of active (1α-hydroxylated) vitamin D compounds is prevalent, or to other high-risk populations. Additionally, recent trials in the CKD population, as well as trials using vitamin D analogs, have been limited. Conclusions Current randomized trials of vitamin D supplementation do not support benefits for cardiovascular health, but the evidence remains inconclusive. Additional randomized trials assessing larger numbers of participants with low baseline vitamin D levels, having longer follow-up periods, and testing higher vitamin D dosages are needed to guide clinical practice.

scholarly journals Vitamin D and Cardiovascular Risk: Which Implications in Children?

2020 ◽  
Vol 21 (10) ◽  
pp. 3536 ◽  
Author(s):  
Silvia Savastio ◽  
Erica Pozzi ◽  
Francesco Tagliaferri ◽  
Roberta Degrandi ◽  
Roberta Cinquatti ◽  
...  
Keyword(s):  
Vitamin D ◽  
Cardiovascular Risk ◽  
Pediatric Patients ◽  
Cardiovascular Effects ◽  
Vitamin D Supplementation ◽  
Risk Markers ◽  
Randomized Controlled ◽  
Increased Risk ◽  
Vitamin D Levels ◽  
Lipid Parameters

Vitamin D (25OHD) pleiotropic effects are widely recognized and studied. Recently, vitamin D cardiovascular effects are gaining interest, especially in children, although the studies present conflicting data. Some randomized controlled trials (RCTs) have demonstrated that cardiovascular risk markers, such as lipid parameters, inflammation markers, blood pressure, and arterial stiffness, are unaffected by vitamin D supplementation. By contrast, other studies show that low vitamin D levels are associated with higher risk of cardiovascular disease (CVD) and mortality, and support that increased risk of these diseases occurs primarily in people with vitamin D deficiency. An update on these points in pediatric patients is certainly of interest to focus on possible benefits of its supplementation.

scholarly journals Suppression of Parathyroid Hormone as a Proxy for Optimal Vitamin D Status: Further Analysis of Two Parallel Studies in Opposite Latitudes

Nutrients ◽  
2020 ◽  
Vol 12 (4) ◽  
pp. 942 ◽  
Author(s):  
Marcela M. Mendes ◽  
Kathryn H. Hart ◽  
Susan A. Lanham-New ◽  
Patrícia B. Botelho
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Total Sample ◽  
Vitamin D Insufficiency ◽  
Vitamin D Supplementation ◽  
Vitamin D Status ◽  
Low Latitude ◽  
Vitamin D Levels ◽  
Cubic Model ◽  
The Relationship

Optimal vitamin D status has commonly been defined as the level of 25-hydroxyvitamin D (25(OH)D) at which parathyroid hormone (PTH) concentrations would be maximally suppressed, represented by an observed minimum plateau. Previous findings indicate a large variation in this plateau, with values ranging from <30 nmol/L up to 100 nmol/L. This disparity in values might be explained by differences in study design and methodology, ethnicity, age, gender and latitude. This study aimed to investigate the concentration of 25(OH)D at which PTH concentrations were suppressed in Brazilian women living in opposite latitudes (high vs. low: i.e., UK and Brazil), during wintertime. Using data from the D-SOL study (Interaction between Vitamin D Supplementation and Sunlight Exposure in Women Living in Opposite Latitudes), the association between 25(OH)D status and PTH levels were examined in 135 Brazilian women (56 living in England and 79 living in Brazil, aged 20–59 years old). Mean PTH concentrations for Brazilian women with vitamin D deficiency (<25 nmol/L) were significantly higher compared to those with vitamin D insufficiency (25–49.9 nmol/L) (p < 0.01), vitamin D adequacy (50–74.9 nmol/L) (p < 0.01) and those with optimal vitamin D status (>75 nmol/L) (p < 0.001). Regression modelling was used to investigate the relationship between serum 25(OH)D and PTH for the sample as a whole and for each group separately. A cubic model was statistically significant for the total sample (p < 0.001), whereas a linear model presented the best fit for Brazilian women living in England (p = 0.04) and there were no statistically significant models fitted for Brazilian women living in Brazil. The cubic model suggests that 25(OH)D concentrations above 70–80 nmol/L are optimal to suppress the parathyroid gland in Brazilian women. These findings contribute to a better understanding of the relationship between 25(OH)D and PTH in populations living in a low latitude location and are of great relevance for discussions regarding the estimation of optimal cut-offs for vitamin D levels in the Brazilian population as well as for other low latitude locations.

scholarly journals Vitamin D accelerates resolution of inflammatory responses during tuberculosis treatment

2012 ◽  
Vol 109 (38) ◽  
pp. 15449-15454 ◽  
Author(s):  
Anna K. Coussens ◽  
Robert J. Wilkinson ◽  
Yasmeen Hanifa ◽  
Vladyslav Nikolayevskyy ◽  
Paul T. Elkington ◽  
...  
Keyword(s):  
Vitamin D ◽  
Antimicrobial Therapy ◽  
Potential Role ◽  
Inflammatory Responses ◽  
Vitamin D Supplementation ◽  
Tuberculosis Treatment ◽  
Sputum Smear ◽  
High Dose ◽  
Increased Risk

Calcidiol, the major circulating metabolite of vitamin D, supports induction of pleiotropic antimicrobial responses in vitro. Vitamin D supplementation elevates circulating calcidiol concentrations, and thus has a potential role in the prevention and treatment of infection. The immunomodulatory effects of administering vitamin D to humans with an infectious disease have not previously been reported. To characterize these effects, we conducted a detailed longitudinal study of circulating and antigen-stimulated immune responses in ninety-five patients receiving antimicrobial therapy for pulmonary tuberculosis who were randomized to receive adjunctive high-dose vitamin D or placebo in a clinical trial, and who fulfilled criteria for per-protocol analysis. Vitamin D supplementation accelerated sputum smear conversion and enhanced treatment-induced resolution of lymphopaenia, monocytosis, hypercytokinaemia, and hyperchemokinaemia. Administration of vitamin D also suppressed antigen-stimulated proinflammatory cytokine responses, but attenuated the suppressive effect of antimicrobial therapy on antigen-stimulated secretion of IL-4, CC chemokine ligand 5, and IFN-α. We demonstrate a previously unappreciated role for vitamin D supplementation in accelerating resolution of inflammatory responses during tuberculosis treatment. Our findings suggest a potential role for adjunctive vitamin D supplementation in the treatment of pulmonary infections to accelerate resolution of inflammatory responses associated with increased risk of mortality.

scholarly journals Vitamin D and COVID-19: evidence and recommendations for supplementation

2020 ◽  
Vol 7 (12) ◽  
pp. 201912
Author(s):  
George Griffin ◽  
Martin Hewison ◽  
Julian Hopkin ◽  
Rose Kenny ◽  
Richard Quinton ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Experimental Models ◽  
Vitamin D Supplementation ◽  
Hospitalized Patients ◽  
Lung Damage ◽  
High Dose ◽  
Vitamin D Levels ◽  
Immune Health ◽  
The Uk

Vitamin D is a hormone that acts on many genes expressed by immune cells. Evidence linking vitamin D deficiency with COVID-19 severity is circumstantial but considerable—links with ethnicity, obesity, institutionalization; latitude and ultraviolet exposure; increased lung damage in experimental models; associations with COVID-19 severity in hospitalized patients. Vitamin D deficiency is common but readily preventable by supplementation that is very safe and cheap. A target blood level of at least 50 nmol l −1 , as indicated by the US National Academy of Medicine and by the European Food Safety Authority, is supported by evidence. This would require supplementation with 800 IU/day (not 400 IU/day as currently recommended in UK) to bring most people up to target. Randomized placebo-controlled trials of vitamin D in the community are unlikely to complete until spring 2021—although we note the positive results from Spain of a randomized trial of 25-hydroxyvitamin D3 (25(OH)D3 or calcifediol) in hospitalized patients. We urge UK and other governments to recommend vitamin D supplementation at 800–1000 IU/day for all, making it clear that this is to help optimize immune health and not solely for bone and muscle health. This should be mandated for prescription in care homes, prisons and other institutions where people are likely to have been indoors for much of the summer. Adults likely to be deficient should consider taking a higher dose, e.g. 4000 IU/day for the first four weeks before reducing to 800 IU–1000 IU/day. People admitted to the hospital with COVID-19 should have their vitamin D status checked and/or supplemented and consideration should be given to testing high-dose calcifediol in the RECOVERY trial. We feel this should be pursued with great urgency. Vitamin D levels in the UK will be falling from October onwards as we head into winter. There seems nothing to lose and potentially much to gain.

scholarly journals Low Vitamin D Levels Predict Mortality in Ankylosing Spondylitis Patients: A Nationwide Population-Based Cohort Study

Nutrients ◽  
2020 ◽  
Vol 12 (5) ◽  
pp. 1400
Author(s):  
Niv Ben-Shabat ◽  
Abdulla Watad ◽  
Aviv Shabat ◽  
Nicola Luigi Bragazzi ◽  
Doron Comaneshter ◽  
...  
Keyword(s):  
Vitamin D ◽  
Cohort Study ◽  
Ankylosing Spondylitis ◽  
Vitamin D Deficiency ◽  
Vitamin D Supplementation ◽  
Health Maintenance ◽  
Increased Risk ◽  
Vitamin D Levels ◽  
All Cause Mortality

In this study, we aimed to examine the effect of vitamin D deficiency on all-cause mortality in ankylosing spondylitis (AS) patients and in the general population. This is a retrospective-cohort study based on the electronic database of the largest health-maintenance organization in Israel. AS patients who were first diagnosed between 2002–2007 were included. Controls were matched by age, gender and enrollment-time. Follow-up continued until death or end of study follow-up on 1 July 2019. Laboratory measures of serum 25-hydroxyvitamin-D levels during the entire follow-up period were obtained. A total of 919 AS patients and 4519 controls with a mean time of follow-up of 14.3 years were included. The mean age at the time of enrollment was 52 years, and 22% of them were females. AS was associated with a higher proportion of vitamin D deficiency (odds ratio 1.27 [95% confidence-interval (CI) 1.03–1.58]). In AS patients, insufficient levels of vitamin D (<30 ng/mL) were significantly associated with increased incidence of all-cause mortality (hazard ratio (HR) 1.59 [95% CI 1.02–2.50]). This association was more prominent with the decrease in vitamin D levels (< 20 ng/mL, HR 1.63 [95% CI 1.03–2.60]; <10 ng/mL, HR 1.79 [95% CI 1.01–3.20]) and among male patients (<30 ng/mL, HR 2.11 [95% CI 1.20–3.72]; <20 ng/mL, HR 2.12 [95% CI 1.19–3.80]; <10 ng/mL, HR 2.23 [95% CI 1.12–4.43]). However, inadequate levels of vitamin D among controls were not associated with an increased all-cause mortality. Our study has shown that vitamin D deficiency is more common in AS patients than controls and is linked to an increased risk for all-cause mortality. These results emphasize the need for randomized-controlled trials to evaluate the benefits of vitamin D supplementation as a secondary prevention of mortality in patients with chronic inflammatory rheumatic disease.

Does the supplementation of vitamin D affect depressive symptoms?

2016 ◽  
Vol 33 (S1) ◽  
pp. S414-S414
Author(s):  
P. Kolarov ◽  
M. Stoimenova
Keyword(s):  
Vitamin D ◽  
Depressive Symptoms ◽  
Vitamin D3 ◽  
Well Being ◽  
Vitamin D Supplementation ◽  
High Dose ◽  
Vitamin D Levels ◽  
Competing Interest ◽  
Development Course ◽  
Course Of Depression

IntroductionDepression has been linked to decreased levels of vitamin D in adults and the altered dietary intake of calcium and vitamin D has been reported to have implications for the development of depressive symptoms. Although, the relation between vitamin D and depression has been established, it is not yet clear whether the supplementation of vitamin D could affect the clinical manifestation of depression. Therefore, the aim of this study was to determine whether the supplementation of vitamin D could affect the development/course of depression.Material and methodsA systematic literature search was performed for randomized control trials (RCTs) in which vitamin D was supplemented and depression was measured.Results and discussionSix studies were identified as being eligible to be included in this review. The results regarding the supplementation of vitamin D and its effect on the course and manifestation of depression were conflicting. One study concluded that the supplementation of vitamin D3 had beneficial effect in depression and another study reported no improvement in the indices of mental well-being in the vitamin D supplemented group and rejected the hypothesis that an annual high dose of vitamin D3 could prevent depressive symptoms. The remainder four studies reported inconclusive results regarding vitamin D supplementation and the course of depression.ConclusionAs current literature displayed contradictory results and no sound conclusion could be drawn regarding the supplementation of vitamin D and its effect on depression, there is a need of RCTs to determine whether the supplementation of vitamin D levels could affect depression.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A pilot study of the immunological effects of high-dose vitamin D in healthy volunteers

2012 ◽  
Vol 18 (12) ◽  
pp. 1797-1800 ◽  
Author(s):  
Aideen C Allen ◽  
Siobhan Kelly ◽  
Sharee A Basdeo ◽  
Katie Kinsella ◽  
Keith J Mulready ◽  
...  
Keyword(s):  
Vitamin D ◽  
Pilot Study ◽  
Mononuclear Cells ◽  
Vitamin D Supplementation ◽  
High Dose ◽  
Clinical Effects ◽  
Peripheral Blood Mononuclear ◽  
Reduced Frequency ◽  
Vitamin D Levels ◽  
25 Oh Vitamin D

Although vitamin D deficiency is considered an environmental factor in multiple sclerosis (MS), the immunological and clinical effects of vitamin D supplementation remain unclear. We performed a pilot study of the immunomodulatory effects of vitamin D in healthy individuals ( n=4), who took 5000–10,000 IU/day of vitamin D over 15 weeks. After 15 weeks of vitamin D supplementation, serum 25(OH) vitamin D levels rose significantly from baseline, with a corresponding increase in IL-10 production by peripheral blood mononuclear cells and a reduced frequency of Th17 cells. These data provide a strong rationale for randomised trials to assess the clinical effects of vitamin D supplementation in MS.

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