Alfacalcidol did not have an effect on microvascular endothelial function in DN patients. Alfacalcidol significantly improved CSBP with trends of improvement in arterial stiffness and peripheral BP. Alfacalcidol appears to be more beneficial in vitamin D-deficient patients.
AimsThe aims of this project were to: 1. Ascertain local perceptions about Vitamin D. 2. Raise awareness about Vitamin D and its health effects. 3. Explore how health information is obtained by members of the local community. 4. Use local views to help direct future public health policy. Methods Mothers attending a local community centre were invited to participate in an interactive discussion and teaching session with local paediatricians about Vitamin D. Data were collected on demographics of the group, awareness of Vitamin D sources, and where they obtained health information.Participants were asked to feedback on the information gained from the session. Responses were collated and thematic analysis used to identify key themes. Results 47 people attended the focus group. The group was mainly female and aged between 12-84 years. 33 (70%) participants were South Asian. The remainder were Black African or White. At the start of the session, 23 (50%) participants were aware of Vitamin D. 19 (40%) participants were aware of its sources and only 8 (17%) knew about the consequences of insuffi ciency. 12 (25%) of the group spent less than 1 h in the sun daily. Three major themes emerged during and following the session from the participants: 1. Improved awareness of sources of Vitamin D.2. Improved knowledge about the consequences Vitamin D defi ciency. 3. Increased awareness of national Vitamin D recommendations. Participants suggested word-of-mouth, community websites and the local Gujarati newspapers as preferred information sources. GP and NHS branded materials were perceived as reliable and accurate sources. Participants reported that confl icting information given by health professionals and the use of jargon caused confusion and worry. The group reported specifi cally not being told about the importance of Vitamin D in breastfeeding infants and children.
Aim
To report the highest recorded vitamin D overdose in a child. This case is also unique in that there was no associated hypercalcaemia and the child did not require treatment.
Methods
A 12-year-old girl of Somali descent was followed up in neurodisability clinic for complex epilepsy and a progressive movement disorder manifesting as ataxia and progressive dystonia. Her diet contained a normal amount of calcium. She was on regular lamotrigine for seizure control. She was found to be vitamin D deficient with a total 25 hydroxyvitamin D level of 32 nmol/l. Her general practitioner was asked to prescribe vitamin D supplements.
In error, she was prescribed and dispensed 100,000 units of colecalciferol a day. She took the prescribed dose over a period of at least 3 months – ingesting at least 150 capsules of 50,000 units each or a total of 7.5 million units. This error came to light when her serum total 25 hydroxyvitamin D level was measured six months later to check whether she had taken enough vitamin D.
A literature search was conducted to look for cases of vitamin D intoxication.
Results
This patient's peak measured serum 25 hydroxyvitamin D level was 671 nmol/L with corresponding serum corrected calcium of 2.44 mmol/L. Her 1,25 dihydroxyvitamin D level a month after this was 254 pmol/L (reference range 40-150) and her parathyroid hormone level was 5.5 pmol/L, which was normal. A renal ultrasound showed no evidence of nephrocalcinosis. She remained asymptomatic and well throughout.
The literature search found no reports of vitamin D overdose of higher magnitude in a child and no relationship between size of overdose and serum calcium. All cases of overdose, from 900,000 to 4.5 million units of vitamin D, were associated with hypercalcaemia, which ranged from 3-4.6 mmol/L and required treatment.
Conclusions
Clinicians are gaining awareness of the need for vitamin D supplementation.
Many medicines in children are prescribed off-licence. It is the responsibility of physicians and pharmacists to ensure they take extra care when prescribing unlicensed medications. Recommendations for vitamin D supplementation, including indications and doses should be made widely available, e.g. in the BNF (British National Formulary).
The results of this study suggest that increased serum levels of anti-C1q autoantibodies are responsible for apoptosis and may play a pathogenic role in SLE patients, especially in active disease.
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