How often do you test Vitamin D levels and does it matter in your ICU?

How often do you test Vitamin D levels and does it matter in your ICU?

 

 

Vitamin D is essentially needed in general population and the critically ill. This vitamin has significant role in maintaining immune function, cardiovascular state, glucose control and mucosal barrier function etc.  

 

70 to 100 % have vitamin D deficiency in the ICU.

 

Vitamin D supplementation is safe in general population and ICU patients. Hypervitaminosis D should be avoided through correct replacement regimen.

 

Normal desirable levels:

Labs report Vitamin D3 levels in two different units; ng/mL & nmol/L

 

1 ng/mL = 2.5 nmol/L
 

Normal value 30-100 ng/mL (75 to 250 nmol/L)

Anything over 100 ng/ml (250 nmol/l) for a prolonged period may be harmful.

Dietary supplement upto 4,000 IU or less per day is considered safe.

 

Supplements comparisons and dose schedules

 

Oral

Orally administered Vitamin D3 partially gets metabolized by the hepatic 25- hydroxylase enzyme and therefore the rise is ill sustained.

Replacement regimen in deficient adults

Oral replacement

Advantage- Easy, Non invasive

Disadvantage – ill sustained correction, poor compliance in long term

Large oral dose - 300000 IU- Continue maintenance dose after 3 months - 60000 per week
or
Weekly dose - 60000 IU per week
  
 

Intramuscular

IM route advantages- Low cost good compliance, sustained level, need not pass through the liver metabolism

300,000 IU Vitamin D3 monthly for 3 months followed by the same dose every 6 months

600000 IU stat then 300000 IU every 6 months.

 

Preparations

Oral- Cap D Rise (60K), Uprise (60K) etc

 

Intramuscular- Inj Arachitol 6L, 3L, 1L, 60K etc for IM injection

 

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Dr. Prashant Kumar

MD, IDCCM, FNB (Critical Care), EDIC, ADHCA, DOA

Editor 'Critical Care WAarticles'

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