ABC of Vitamin D in Critical Care

 ABC of Vitamin D in Critical Care
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Vitamin D has multiple functions in the human body. In both general population and the critically ill vitamin deficiency is very common. Morality risk decrease as the level reaches towards the normal.

It is clearly established that low vitamin D level is associated with increased ICU stay and mortality.  Supplementation of Vitamin D in short term is quite safe with mild hypercalcaemia if any in hypervitaminosis which remains quite harmless and needs no intervention.

Antimicrobial and Immune-Modulatory Effects of Vitamin D Provide Promising Antibiotics Independent Approaches to Tackle Bacterial Infections.


What is the recommendation for Vitamin D supplementation?

The Recommended Daily Intake (RDI) of Vitamin D3 is 600IU for normal healthy persons. But at this rate it will take days to months to correct deficiency if any.
 
According to the ESPEN (2019) guidelines plasma level should be measure in all patients in critical illness. The reason for this is that if the initial level of Vitamin D is very low (< 12.5ng/ml) correction is very difficult with routine supplementation and massive dose is needed.


What is the recommended dose for correction?

Measured Vitamin D level- Normal range to Mild deficiency – Vitamin D3 dose 60000IU weekly or on day 0 and Day 4

Measured Vitamin D level severe deficiency (< 12.5ng/ml) - Vitamin D3 dose 500000 IU (Five Lakhs) to be administered within a week of admission. This massive initial dose is necessary to correct the deficiency and is quite safe in this range. The route may either be IV/ IM or oral.


Should vitamin D supplementations practiced widely?

Up to 80% of the ICU patients need ultra high dose of 200000 to 500000 UI by oral, IV, or IM routes to rapidly normalize the deficiency.

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Please share how or not do you correct Vitamin D deficiency in your patients?
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Dr. Prashant Kumar

Ref:
Singer P. et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clinical Nutrition 38 (2019) 48e79.

Nair P wt al. Vitamin D deficiency and supplementation in critical illness—the known knowns and known unknowns. Critical Care (2018) 22:276.  

Preparations Available:
Parenteral
Arachitol 6L Injection
Curevit D3
CALCIMINN INJ
Calvis
D-OR

Oral
Cap Uprise-D3 60K Capsule
D-Rise Granules 60K
Tab D3 Must 60K
Cap Dolimo D3 60K

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