Vitamin D and critical illness: what endocrinology can learn from intensive care and vice versa.
Endocr Connect. 2018 Dec 1;7(12):R304-R315. doi: 10.1530/EC-18-0184.
Amrein K1,2, Papinutti A3, Mathew E3,4, Vila G5, Parekh D6.
- ICU adults getting 540,000 IU of Vitamin D were 2X more likely to be alive 30 days later – RCT June 2019
- Off topic: Improving your health BEFORE surgery (prehabilitation) helps your recovery - 2018
- 10 fewer days of ICU Mechanical Ventilation 300,000 IU injection of vitamin D – RCT March 2019
Important ICU Considerations - by Vitamin D Life
- Start the Vitamin Dosing before the surgery if at all possible
- Outcomes will be far better
- Add vitamin D if < 30 ng, not just < 12 ng
- Surgery/trauma reduces the vitamin D levels in a few days
- Use a gut-compatible form of vitamin D if there is a chance that the patient has poor gut (~30% of patients)
- Allocate some of the Vitamin D loading dose to very fast response type - inside the cheek or under the tongue
- raises vitamin D levels in ~3 hours instead of 12 hours
- Obese need larger doses to get to the same blood level
- Test vitamin D levels about a week after surgery/ICU - and replenish if < 30 ng
- Many studies have found that Omega-3 helps as well
- Avoid use of injection (too slow) and Vitamin D2 - poor response
- Consider adding something to increase amount of vitamin D which acutally gets to tissue
- Resveratrol, etc increase the activation of the Vitamin D Receptor
Download the PDF from Vitamin D Life
Large ongoing ICU trial starts with 540,000 IU
The prevalence of vitamin D deficiency in intensive care units ranges typically between 40 and 70%. There are many reasons for being or becoming deficient in the ICU. Hepatic, parathyroid and renal dysfunction additionally increases the risk for developing vitamin D deficiency. Moreover, therapeutic interventions like fluid resuscitation, dialysis, surgery, extracorporeal membrane oxygenation, cardiopulmonary bypass and plasma exchange may significantly reduce vitamin D levels. Many observational studies have consistently shown an association between low vitamin D levels and poor clinical outcomes in critically ill adults and children, including excess mortality and morbidity such as acute kidney injury, acute respiratory failure, duration of mechanical ventilation and sepsis. It is biologically plausible that vitamin D deficiency is an important and modifiable contributor to poor prognosis during and after critical illness. Although vitamin D supplementation is inexpensive, simple and has an excellent safety profile, testing for and treating vitamin D deficiency is currently not routinely performed. Overall, less than 800 patients have been included in RCTs worldwide, but the available data suggest that high-dose vitamin D supplementation could be beneficial. Two large RCTs in Europe and the United States, together aiming to recruit >5000 patients, have started in 2017, and will greatly improve our knowledge in this field. This review aims to summarize current knowledge in this interdisciplinary topic and give an outlook on its highly dynamic future.