Prophylaxis of folate deficiency in acutely ill patients: results of a randomized clinical trial

Abstract

A trial was carried out of prophylaxis of folate deficiency in 105 acutely ill patients immediately following admission to an ICU with evaluation of folate status. These patients were fed either orally or by enteral or parenteral nutrition. Three groups were established regardless of the type of nutrition: - Group 1 received 5 mg/day parenteral folinic acid; - Group 2 received 50 mg/week parenteral folinic acid; - Group 3 received no parenteral folinic acid. Before treatment, 19% of the patients presented very low serum folate levels (less than 2.7 ng/ml). Two of them developed acute folate deficiency with severe hematological disturbances quite reversed with folinic acid. Folate levels were inversely correlated with the severity of the clinical status and were lower in septic and feverish patients. The effect of folinic acid administration was assessed after seven days of treatment: daily administration of 5 mg folinic acid appeared to be the best regimen with normalization of serum folate levels in all cases; results appeared to be better than with 50 mg once weekly. Oral and enteral administration of folate supplies considered to be physiological (300 micrograms/day folic acid) did not appear to be sufficient to normalize in all cases blood folate levels in these acutely ill patients.

Serum concentrations and clearances of folic acid and pyridoxal-5′-phosphate during venovenous continuous renal replacement therapy

“…Campillo and colleagues [12] have demonstrated that 19 % of patients admitted to their ICU were deficient in folic acid upon arrival, as monitored by serum levels. Furthermore, among their patients, they have documented two cases of acute folate defiency presenting as low blood cell counts with corresponding acute changes in the bone marrow.…”

“…We may rely on the study of Campillo et al who demonstrated that critically ill patients without folic acid supplementation had no reduction in their serum and erythrocyte folic acid concentrations over time (after 7 days of stay in the ICU) [12]. No such data are available for vitamin B6 or P-5¢-P.…”

Micronutrient deficiency in critical illness: an invisible foe?

“…Given the difficult clinical and laboratory diagnosis for both deficiencies, prophylactic administration may provide a cost-effective alternative. In a small RCT, parenteral folate at 5 mg/day appeared safe [12]. generated the hypothesis that correction of very low levels may increase survival [8].…”

The Hematologic System as a Marker of Organ Dysfunction in Sepsis

“…Other contributing factors include disseminated intravascular coagulation (DIC), pathogen-associated hemolysis, hypoadrenalism, and nutritional deficiency. [56][57][58] Figure 3. Sepsis and the acute phase response result in anemia of inflammation, characterized by iron sequestration in monocytes/macrophages, decreased erythropoietin (Epo) production, and blunted bone marrow response to Epo.…”