scholarly journals SAT-397 Characteristics and Outcomes of Severe Hypercalcemia Related Admissions - a Single Centre 5 Years’ Experience

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Jo-Anne Ponce ◽  
Myron Lee ◽  
Amanda Caswell ◽  
Mclaine O Parsons ◽  
Shamasunder Acharya
Keyword(s):  
Vitamin D ◽  
Calcium Level ◽  
Calcium Supplementation ◽  
General Medicine ◽  
Vitamin D Supplementation ◽  
Tertiary Referral Center ◽  
Icu Admission ◽  
Antiresorptive Agent ◽  
Severe Hypercalcemia ◽  
Severe Hypercalcaemia

Abstract Introduction: Severe hypercalcemia (corrected calcium ≥3.5mmol/L) is typically associated with multi-organ dysfunction and increased mortality. We audited 47 consecutive patients who were admitted to a single tertiary referral center over 5 years period (2014-2019) with severe hypercalcemia. Results: The median age 69 years (10-97yrs); 55% females, and median length of stay was 9 days (1-120). Most patients (30%) were admitted under general medicine and 53% received endocrinology consultation. Renal dysfunction (91%) dominated the clinical presentation, but gastrointestinal abnormalities (70%), neuropsychiatric manifestations (53%), and musculoskeletal involvement (45%) were also very common. PTH was measured in 43/47 patients with 37 PTH independent (calcium level 3.82 mmol/L) and 6 PTH dependent (calcium level 3.70mmol/L) hypercalcemia. Recurrence of the condition within five years was recorded for 5 patients (11%), ten (21%) patients died during the admission, and 4 patients (9%) required ICU admission in PTH independent severe hypercalcaemia, majority are due to malignancy; while none of these outcomes were observed in PTH dependent severe hypercalcaemia. The length of hospital stay is longer in PTH independent (15.5 days) as compared to PTH dependent severe hypercalcaemia (12 days). The most common cause of severe hypercalcemia was malignancy (47%) with multiple myeloma as the most common in 32% followed by lung cancer at 27%. The other non-malignancy causes are calcium supplementation, vitamin D toxicity, and hyperparathyroidism implicated in 13% each. Twenty eight patients (65%) were managed by fluid and antiresorptive agent with 26 patients able to decrease calcium level to <3mmol/L (93%). Eight patients (19%) were managed by fluid alone (not effective in 37%), 9% by antiresorptive agent alone (not effective in 25%), and 16% did not receive any fluid nor antiresorptive agent (not effective in 43%). Conclusion: Similar to previous studies, severe hypercalcaemia is commonly seen in patients with malignancy and associated with significant symptoms, recurrence in 5 years, ICU admission and mortality. Calcium and vitamin D supplementation and hyperparathyroidism are also found to commonly cause severe hypercalcemia. The most effective management is combination of fluid resuscitation and antiresorptive agent to decrease the calcium level to <3mmol/L.

The Effect of Calcium or Calcium and Vitamin D Supplementation on Bone Mineral Density in Healthy Males: A Systematic Review and Meta-Analysis

2015 ◽  
Vol 25 (5) ◽  
pp. 510-524 ◽  
Author(s):  
Leslie N. Silk ◽  
David A. Greene ◽  
Michael K. Baker
Keyword(s):  
Bone Mineral Density ◽  
Systematic Review ◽  
Vitamin D ◽  
Lumbar Spine ◽  
Calcium Supplementation ◽  
Meta Analysis ◽  
Vitamin D Supplementation ◽  
Mineral Density ◽  
Total Body ◽  
Healthy Males

Research examining the preventative effects of calcium and vitamin D supplementation has focused on children and females, leaving the effects on male bone mineral density (BMD) largely unexplored. Thus, the aim of this systematic review and meta-analysis is to examine the efficacy of calcium supplementation, with or without vitamin D for improving BMD in healthy males. Medline, EMBASE, SPORTDiscus, Academic Search Complete, CINHAHL Plus and PubMed databases were searched for studies including healthy males which provided participants calcium supplementation with or without vitamin D and used changes to BMD as the primary outcome measure. Between trial standardized mean differences of percentage change from baseline in BMD of femoral neck, lumbar spine, total body and total hip sites were calculated. Nine studies were included in the systematic review with six references totaling 867 participants contributing to the meta-analysis. Significant pooled effects size (ES) for comparison between supplementation and control groups were found at all sites included in the meta-analysis. The largest effect was found in total body (ES = 0.644; 95% CI = 0.406–0.883; p < .001), followed by total hip (ES = 0.483, 95% CI= 0.255–0.711, p < .001), femoral neck (ES = 0.402, 95% CI = 0.233–0.570, p = .000) and lumbar spine (ES = 0.306, 95% CI = 0.173–0.440, p < .001). Limited evidence appears to support the use of calcium and vitamin D supplementation for improving BMD in older males. There is a need for high quality randomized controlled trials, especially in younger and middle-aged male cohorts and athletic populations to determine whether supplementation provides a preventative benefit.

scholarly journals Vitamin D Status and Severe COVID-19 Disease Outcomes in Hospitalized Patients

2021 ◽  
Vol 12 ◽  
pp. 215013272110412
Author(s):  
Jennifer L. Pecina ◽  
Stephen P. Merry ◽  
John G. Park ◽  
Tom D. Thacher
Keyword(s):  
Vitamin D ◽  
Assisted Ventilation ◽  
Vitamin D Supplementation ◽  
Hospitalized Patients ◽  
Vitamin D Status ◽  
Icu Admission ◽  
Hydroxyvitamin D ◽  
Duration Of Hospitalization ◽  
D Values ◽  
Relationship Of

Background: Vitamin D deficiency may increase the risk of severe COVID-19 disease. Objectives: To determine if 25-hydroxyvitamin D [25(OH)D] levels in patients hospitalized for COVID-19 were associated with the clinical outcomes of days on oxygen, duration of hospitalization, ICU admission, need for assisted ventilation, or mortality. Methods: We conducted a retrospective study of 92 patients admitted to the hospital with SARS-CoV-2 infection between April 16, 2020 and October 17, 2020. Multivariable regression was performed to assess the independent relationship of 25(OH)D values on outcomes, adjusting for significant covariates and the hospitalization day the level was tested. Results: About 15 patients (16.3%) had 25(OH)D levels <20 ng/mL. Only 1 patient (3.4%) who had documented vitamin D supplementation prior to admission had 25(OH)D <20 ng/mL. Serum 25(OH)D concentrations were not significantly associated with any of our primary outcomes of days on oxygen, duration of hospitalization, intensive care unit (ICU) admission, need for mechanical ventilation, or mortality in any of the adjusted multivariable models. Adjusting for the hospital day of 25(OH)D sampling did not alter the relationship of 25(OH)D with any outcomes. Conclusion: Vitamin D status was not related to any of the primary outcomes reflecting severity of COVID-19 in hospitalized patients. However, our sample size may have lacked sufficient power to demonstrate a small effect of vitamin D status on these outcomes.

Calcium-Alkali Syndrome Associated with Hypoparathyroidism Following Total Thyroidectomy

2020 ◽  
Vol 51 (2) ◽  
pp. 160-167
Author(s):  
Sayaka Kuroya ◽  
Masahiko Yazawa ◽  
Yugo Shibagaki ◽  
Naoto Tominaga
Keyword(s):  
Vitamin D ◽  
Renal Impairment ◽  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Calcium Level ◽  
Serum Calcium Level ◽  
Metabolic Alkalosis ◽  
Calcium Supplementation ◽  
Parathyroid Autotransplantation ◽  
High Calcium

Background: Patients with permanent postsurgical hypoparathyroidism, a complication of total thyroidectomy, often require high calcium supplementation with vitamin D to maintain serum calcium levels. The epidemiology of calcium-alkali syndrome (CAS) in patients with hypoparathyroidism after total thyroidectomy remains unclear. This study aimed to investigate the incidence of hypercalcemia, renal impairment, metabolic alkalosis, and CAS in patients treated for presumed hypoparathyroidism after total thyroidectomy. Methods: Twenty-seven patients with neck cancers who underwent total thyroidectomy without parathyroid autotransplantation between January 2010 and October 2013 at our hospital were consecutively included. All patients received calcium lactate and alfacalcidol for postsurgical hypocalcemia. We defined hypercalcemia as a corrected serum calcium level (cCa) ≥10.5 mg/dL, metabolic alkalosis as a difference in serum sodium and serum chloride ([sNa-sCl]) ≥39 mEq/L, and renal impairment as a ≥50% increase in serum creatine and/or ≥35% decrease in estimated glomerular filtration rate (eGFR) compared to baseline. Results: cCa peaked (11.1 ± 1.5 mg/dL) at a median of 326 days (interquartile range 78–869) after surgery. At peak cCa, [sNa-sCl] was significantly higher (p < 0.01), and eGFR was significantly lower (p < 0.01) than that at baseline. Fifteen patients (55.6%) had hypercalcemia, 19 (70.3%) had alkalosis, 12 (44.4%) had renal impairment, and 9 (33.3%) had CAS. Patients with CAS (mean age 67.1 ± 10.8 years) were older than those without CAS (56.7 ± 13.6 years, p = 0.06). The mean dose of alfacalcidol in the CAS group (3.1 ± 1.2 μg/day) was significantly larger than that in the non-CAS group (2.1 ± 1.0 μg/day, p = 0.03). Conclusions: This retrospective study reveals the high incidence of CAS in patients with hypoparathyroidism after total thyroidectomy. Furthermore, these findings suggest that the serum calcium level, acid-base balance, and renal function should be closely monitored in patients with postsurgical hypoparathyroidism who receive large doses of active vitamin D.

scholarly journals Relation between vitamin D deficiency and osteoarthritis

2020 ◽  
Vol 4 (1) ◽  
pp. 1-4
Author(s):  
Ahmad Gharaibeh
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Calcium Level ◽  
Vitamin D Supplementation ◽  
University Hospital ◽  
Phosphorus Level ◽  
Normal Range ◽  
Health Records ◽  
The Mean ◽  
The Relationship

Purpose of the Work: The main objective of our work is to determine the relationship between osteoarthritis and deficiency of vitamin D in our region in central Europe and to make a database for further researches, to be effective in investigating, controlling, and preventing OA and vitamin D deficiency in our population. Methodology: We perform a retrospective study in adult patients≥25years with osteoarthritis big joints from their health records, which were seen at the osteology clinic of University Hospital Louise Pasteur during the year 2018. The authors analyse the blood tests of Vitamin D level, calcium level, phosphorus level, B ALP, glomerular filtration rate (GFR) levels in the serum of these patients. Results: There were 47 patients with osteoarthritis. All of these patients had Vitamin D deficiency. The mean age of our group is 71 years. 12.8% (7) are male and 87.2% (41)are female. The mean of vitamin D is 24mmol/l (normal range 75-200 nmol/l), Calcium level with in normal range, Phosphorus level mean was within normal range and B ALP level within normal. Conclusion: Osteoarthritis increased by deficiency of vitamin D level in blood serum and increasing with age. Vitamin D is a fat-soluble vitamin that regulates calcium and phosphorus metabolism, maintenance of the normal skeletal and muscular systems. Most of the patients show OA in hip and knee and in advanced age 71 years. Vitamin D supplementation may be a safe method to treat and prevent OA.

scholarly journals Vitamin D Supplementation in Sarcoidosis: A Double-Edged Sword

2021 ◽  
Author(s):  
Rishikesh Chandran ◽  
Lakshmi Nagendra ◽  
Shrikrishna Acharya ◽  
Giridhar Belur Hosmane ◽  
Vijith Shetty ◽  
...  
Keyword(s):  
Vitamin D ◽  
Disease Activity ◽  
Bone Health ◽  
Calcium Metabolism ◽  
Vitamin D Supplementation ◽  
Osteoporosis Prevention ◽  
Hydroxyvitamin D ◽  
Severe Hypercalcemia ◽  
25 Hydroxyvitamin D

AbstractSarcoidosis is complicated by disordered vitamin D and calcium metabolism, which has important implications on disease activity and bone health. Although the majority of the patients with sarcoidosis are typically deficient in 25-hydroxyvitamin D, repletion of vitamin D is controversial in light of the hypercalcemia risk. Presently, there are no clear guidelines regarding vitamin D supplementation as a part of osteoporosis prevention in patients with vitamin D deficiency and sarcoidosis. We report a patient with sarcoidosis who presented with severe hypercalcemia following vitamin D supplementation and review the debated role of vitamin D supplementation in vitamin D-deficient sarcoid patients.

scholarly journals Prevalence and Determinants of Vitamin D Deficiency in Children Aged 0–5 years in Jiangsu Province of China: A Cross-Sectional Multicenter Study

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1859-1859
Author(s):  
Yan Zhao ◽  
Rui Qin ◽  
Xianghua Ma ◽  
Xinhua Zhang ◽  
Hong Hong ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Multicenter Study ◽  
Calcium Supplementation ◽  
Vitamin D Supplementation ◽  
Jiangsu Province ◽  
Initial Time ◽  
Categorical Variables ◽  
Outdoor Activity ◽  
Vitamin D Levels

Abstract Objectives To explore the vitamin D status and its related factors in infants and preschool. Methods This was a large population-based multicenter study in which the representative children aged 0–5 years were recruited from 12 Children's Health Care Centers by a stratified cluster random-sampling method in 10 cities of Jiangsu Province, China. Kruskal-wallis test was used to describe median differences by continuous variables and chi-square test was used to examine differences in categorical variables. The associations between characteristics and risk factors with vitamin D deficiency and 25(OH)D level were used to evaluate by binary logistic regression and general linear model regression. Results A total of 5289 children (2786 boys and 2503 girls) were investigated. The prevalence of deficiency vitamin D were 30.1%, The overall level of 25(OH)D was 64.0 (46.3 ∼ 83.0) nmol/ml. 0–5 year old children with higher odds of vitamin D deficiency and lower 25(OH)D level were more likely to be at older age, girls, survey in spring, location in southern of Jiangsu province, preference for meat and sweets, meat intake &gt; 150.0 g/d, time of sleeping &lt; 10 h/d and outdoor activity &lt; 2 h/d (all P &lt; 0.05). However, those with lower odds of vitamin D deficiency and higher 25(OH)D level were more likely to be the number of parity≥ 2 times, milk intake ≥ 250 ml/d, vitamin D supplementation from birth to 6 months, the initial time of vitamin D supplementation after birth ≤ 1 months, vitamin D supplementation and calcium supplementation in the last 3 months, and daily dose of vitamin D supplementation &gt; 400 IU (all P &lt; 0.05). Conclusions Most 0–5 year old children in Jiangsu province have poor vitamin D levels. The 25(OH)D levels and vitamin D deficiency were associated with age, gender, parity, season of survey, region of residence, daily intake of milk, meat, vitamin D and calcium supplementation, the initial time of vitamin D supplementation after birth, preference for eating meat and sweets, time of sleeping and outdoor activity every day for children. Funding Sources This work was funded by the construction fund for key subjects of women and children of Jiangsu Province (FXK201203).

scholarly journals Severe hypercalcaemia syndrome with daily low-dose vitamin D supplementation

Rheumatology ◽  
1997 ◽  
Vol 36 (6) ◽  
pp. 712-713 ◽  
Author(s):  
T. L. Jansen ◽  
M. Janssen ◽  
A. J. de Jong
Keyword(s):  
Vitamin D ◽  
Low Dose ◽  
Vitamin D Supplementation ◽  
Severe Hypercalcaemia

scholarly journals Type of Dietary Fat Is Associated with the 25-Hydroxyvitamin D3 Increment in Response to Vitamin D Supplementation

2011 ◽  
Vol 96 (10) ◽  
pp. 3170-3174 ◽  
Author(s):  
Sathit Niramitmahapanya ◽  
Susan S. Harris ◽  
Bess Dawson-Hughes
Keyword(s):  
Fatty Acids ◽  
Vitamin D ◽  
Vitamin D3 ◽  
Calcium Supplementation ◽  
Controlled Trial ◽  
Saturated Fatty Acids ◽  
Vitamin D Supplementation ◽  
Dietary Fats ◽  
Double Blind ◽  
Pufa Ratio

Abstract Context: Mono- and polyunsaturated fats may have opposing effects on vitamin D absorption. Objective: The purpose of this study was to determine whether intakes of different dietary fats are associated with the increase in serum 25-hydroxyvitamin D (25OHD) after supplementation with vitamin D3. Design, Setting, and Participants: This analysis was conducted in the active treatment arm of a randomized, double-blind, placebo-controlled trial of vitamin D and calcium supplementation to prevent bone loss and fracture. Subjects included 152 healthy men and women age 65 and older who were assigned to 700 IU/d vitamin D3 and 500 mg/d calcium. Intakes of monounsaturated fatty acids (MUFA), polyunsaturated fatty acids (PUFA), and saturated fatty acids (SFA) were estimated by food frequency questionnaire. Main Outcome Measure: The change in plasma 25OHD during 2 yr vitamin D and calcium supplementation was assessed. Results: The change in plasma 25OHD (nanograms per milliliter) during vitamin D supplementation was positively associated with MUFA, (β = 0.94; P = 0.016), negatively associated with PUFA, (β = −0.93; P = 0.038), and positively associated with the MUFA/PUFA ratio (β = 6.46; P = 0.014). Conclusion: The fat composition of the diet may influence the 25OHD response to supplemental vitamin D3. Diets rich in MUFA may improve and those rich in PUFA may reduce the effectiveness of vitamin D3 supplements in healthy older adults. More studies are needed to confirm these findings.

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