Dose-response effect of ergocalciferol therapy on serum 25-hydroxyvitamin D concentration during critical illness

Roland Dickerson, Scott C. Berry, Jamie D. Ziebarth, Joseph Swanson, George O. Maish, Gayle Minard, Rex O. Brown

Research output: Contribution to journalArticle

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Abstract

Objective: The aim of this study was to evaluate the dose-response relationship between ergocalciferol therapy and serum 25-hydroxyvitamin D concentrations in enterally fed, critically ill patients with traumatic injuries. Methods: A retrospective cohort of critically ill patients with traumatic injuries and vitamin D deficiency (25-OH vitamin D <50 nmol/L) were given either 50 000 IU of liquid ergocalciferol weekly, twice weekly, or three times weekly while in the intensive care unit (ICU). Serum 25-OH vitamin D and ionized calcium concentrations were monitored weekly. Ergocalciferol therapy was stopped when the serum 25-OH vitamin D was >75 nmol/L, if the patient experienced hypercalcemia (ionized calcium >1.34 mmol/L), when the patient was discharged from the ICU, or if enteral nutrition was discontinued. Results: Sixty-five patients (16, 18, and 31 per dosage group) were examined. One (6%), two (11%), and eight (26%) patients achieved normal 25-OH vitamin D concentrations after 2 to 4 wk of ergocalciferol therapy for each dosage group, respectively (P < 0.001). Serum 25-OH vitamin D concentrations improved from 36 ± 6, 40 ± 7, and 37 ± 6 nmol/L to 50 ± 15, 54 ± 21, and 62 ± 17 nmol/L, respectively, after 2 wk of ergocalciferol therapy (P < 0.001) Two (13%), one (6%), and seven (23%) patients developed hypercalcemia for each dosage group, respectively (P = NS). Conclusions: Ergocalciferol therapy improved baseline serum 25-OH vitamin D concentrations but was inadequate for consistently achieving normal serum concentrations of 25-OH vitamin D during critical illness. The trend in increasing appearance of mild hypercalcemia for the highest dosage group is concerning.

Original languageEnglish (US)
Pages (from-to)1219-1223
Number of pages5
JournalNutrition
Volume31
Issue number10
DOIs
StatePublished - Oct 1 2015

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Ergocalciferols
Critical Illness
Vitamin D
Serum
Hypercalcemia
Therapeutics
Vitamin D Deficiency
Wounds and Injuries
Enteral Nutrition
25-hydroxyvitamin D
Calcium

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics

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Dose-response effect of ergocalciferol therapy on serum 25-hydroxyvitamin D concentration during critical illness. / Dickerson, Roland; Berry, Scott C.; Ziebarth, Jamie D.; Swanson, Joseph; Maish, George O.; Minard, Gayle; Brown, Rex O.

In: Nutrition, Vol. 31, No. 10, 01.10.2015, p. 1219-1223.

Research output: Contribution to journalArticle

Dickerson, Roland ; Berry, Scott C. ; Ziebarth, Jamie D. ; Swanson, Joseph ; Maish, George O. ; Minard, Gayle ; Brown, Rex O. / Dose-response effect of ergocalciferol therapy on serum 25-hydroxyvitamin D concentration during critical illness. In: Nutrition. 2015 ; Vol. 31, No. 10. pp. 1219-1223.
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abstract = "Objective: The aim of this study was to evaluate the dose-response relationship between ergocalciferol therapy and serum 25-hydroxyvitamin D concentrations in enterally fed, critically ill patients with traumatic injuries. Methods: A retrospective cohort of critically ill patients with traumatic injuries and vitamin D deficiency (25-OH vitamin D <50 nmol/L) were given either 50 000 IU of liquid ergocalciferol weekly, twice weekly, or three times weekly while in the intensive care unit (ICU). Serum 25-OH vitamin D and ionized calcium concentrations were monitored weekly. Ergocalciferol therapy was stopped when the serum 25-OH vitamin D was >75 nmol/L, if the patient experienced hypercalcemia (ionized calcium >1.34 mmol/L), when the patient was discharged from the ICU, or if enteral nutrition was discontinued. Results: Sixty-five patients (16, 18, and 31 per dosage group) were examined. One (6{\%}), two (11{\%}), and eight (26{\%}) patients achieved normal 25-OH vitamin D concentrations after 2 to 4 wk of ergocalciferol therapy for each dosage group, respectively (P < 0.001). Serum 25-OH vitamin D concentrations improved from 36 ± 6, 40 ± 7, and 37 ± 6 nmol/L to 50 ± 15, 54 ± 21, and 62 ± 17 nmol/L, respectively, after 2 wk of ergocalciferol therapy (P < 0.001) Two (13{\%}), one (6{\%}), and seven (23{\%}) patients developed hypercalcemia for each dosage group, respectively (P = NS). Conclusions: Ergocalciferol therapy improved baseline serum 25-OH vitamin D concentrations but was inadequate for consistently achieving normal serum concentrations of 25-OH vitamin D during critical illness. The trend in increasing appearance of mild hypercalcemia for the highest dosage group is concerning.",
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AU - Dickerson, Roland

AU - Berry, Scott C.

AU - Ziebarth, Jamie D.

AU - Swanson, Joseph

AU - Maish, George O.

AU - Minard, Gayle

AU - Brown, Rex O.

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AB - Objective: The aim of this study was to evaluate the dose-response relationship between ergocalciferol therapy and serum 25-hydroxyvitamin D concentrations in enterally fed, critically ill patients with traumatic injuries. Methods: A retrospective cohort of critically ill patients with traumatic injuries and vitamin D deficiency (25-OH vitamin D <50 nmol/L) were given either 50 000 IU of liquid ergocalciferol weekly, twice weekly, or three times weekly while in the intensive care unit (ICU). Serum 25-OH vitamin D and ionized calcium concentrations were monitored weekly. Ergocalciferol therapy was stopped when the serum 25-OH vitamin D was >75 nmol/L, if the patient experienced hypercalcemia (ionized calcium >1.34 mmol/L), when the patient was discharged from the ICU, or if enteral nutrition was discontinued. Results: Sixty-five patients (16, 18, and 31 per dosage group) were examined. One (6%), two (11%), and eight (26%) patients achieved normal 25-OH vitamin D concentrations after 2 to 4 wk of ergocalciferol therapy for each dosage group, respectively (P < 0.001). Serum 25-OH vitamin D concentrations improved from 36 ± 6, 40 ± 7, and 37 ± 6 nmol/L to 50 ± 15, 54 ± 21, and 62 ± 17 nmol/L, respectively, after 2 wk of ergocalciferol therapy (P < 0.001) Two (13%), one (6%), and seven (23%) patients developed hypercalcemia for each dosage group, respectively (P = NS). Conclusions: Ergocalciferol therapy improved baseline serum 25-OH vitamin D concentrations but was inadequate for consistently achieving normal serum concentrations of 25-OH vitamin D during critical illness. The trend in increasing appearance of mild hypercalcemia for the highest dosage group is concerning.

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