The Impact of High-Dose Vitamin D on Hemoglobin Concentrations in Critical Illness
The FASEB Journal, vol. 29 no. 1 Supplement 920.5 April 2015
Ellen Smith1, Jennifer Jones1, Jenny Han1, Jessica Alvarez1, Ellen Chiang1, Greg Martin1, Thomas Ziegler1 and Vin Tangpricha1
1 Department of Medicine Emory University Atlanta GA United States
Critical illness requiring mechanical ventilation
500,000 IU loading dose helped, but 250,000 IU did not
Loading dose give over a 5 day period – perhaps 100,000 IU each day
| Initially | Weekly increase | Total after 1 month? | |
| Hemoglobin | 9.7 g/dL | 0.8 g/dL | 12.9 g/dL |
Note: Enteral supplementation = normal, through the mouth
See also Vitamin D Life
Overview Loading of vitamin D
400,000 IU of vitamin D reduced adult pain and improved quality of life – March 2014
Vitamin D 100,000 IU daily was OK for Dr. Cannell for 6 months – Jan 2015
Vitamin D loading doses of up to 400,000 IU OK for adolescents – meta-analysis Dec 2014
Critically ill need vitamin D – how much and which test to use is TBD – Nov 2014
Large single dose of more than 300,000 IU of vitamin D works well for 3 months – Review Nov 2013
2X increased chance of anemia (low iron) associated with low vitamin D – Sept 2013
Iron deficiency is a cause of Vitamin D deficiency - one Iron supplment is much better
5X more likely to be vitamin D deficient if anemic - Dec 2012
Objective: Anemia and vitamin D deficiency are highly prevalent in critically ill patients, and vitamin D may be involved in the regulation of iron recycling. The purpose of this study was to examine the impact of vitamin D therapy on hemoglobin concentrations in critically ill patients.
Methods: We conducted a secondary analysis of a randomized, double-blinded, placebo-controlled trial of high-dose vitamin D3 (D3) therapy in critically ill adults requiring mechanical ventilation (N=30). Participants were randomized to receive a total enteral dose of 500,000 IU D3, 250,000 IU D3, or placebo administered over 5 days. Blood was drawn weekly throughout hospitalization for up to 4 weeks. Linear mixed effects models were used to assess change in hemoglobin concentration by treatment group over time.
Results: The prevalence of anemia at baseline was 93.3%. Baseline mean hemoglobin and plasma 25-hydroxyvitamin D concentrations were 9.7 g/dL (SD=1.9) and 21.4 ng/mL (SD=9.1), respectively, and did not differ significantly across treatment groups. In the 250,000 IU D3 group, change in hemoglobin over time did not differ from placebo (P=0.5). However, in the group who received 500,000 IU D3, hemoglobin concentrations increased by 0.8 g/dL (SE=0.3) per week (P=0.005).
Conclusion: In this population of critically ill patients, treatment with 500,000 IU D3 over 5 days increased hemoglobin concentrations during hospitalization, while no significant change in hemoglobin was observed in the 250,000 IU D3 or placebo groups. These findings support a role for vitamin D in improving hemoglobin concentrations in critical illness, which should be confirmed in larger studies.
Funding: T32 DK7734-17, R21 HL110044