Transplant Recipients on the Edge of the Hypocalcemia Abyss

Lee, Paul; Samaras, Katherine; Glanville, Allan R.

doi:10.1016/j.healun.2008.09.010

Cited by 10 publications

(8 citation statements)

References 11 publications

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“…Since the mid-1990s, several laboratories in various parts of the world have consistently reported aromatase mRNA and enzyme activity in endometriotic tissues and cells. [1][2][3][4] My colleagues and I have reported the presence of aromatase in endometriosis, and we have described the signaling pathway responsible for coordinated induction of aromatase and other steroidogenic genes required for the production of estradiol from cholesterol in endometriotic tissue. 1 The letter by Colette and Donnez contradicts their recently published article in which they reported that aromatase mRNA was detected in all but 2 of the approximately 60 samples of ovarian, peritoneal, and deep endometriotic tissues they studied.…”

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confidence: 94%

Vitamin D Deficiency in Critically Ill Patients

Lee¹,

Eisman²,

Center³

2009

N Engl J Med

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233

116

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confidence: 94%

Vitamin D Deficiency in Critically Ill Patients

Lee¹,

Eisman²,

Center³

2009

N Engl J Med

Self Cite

233

116

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“…Various forms of calcium and calcitriol supplementation were unable to demonstrate sustained effects and in some cases resulted in hypercalcemia and increased mortality [2]. Several case reports have suggested vitamin D deficiency as a cause of hypocalcemia with adverse outcome, which can be corrected effectively and safely by vitamin D supplementation [4,5]. …”

Section: Introductionmentioning

confidence: 99%

Short-term effects of high-dose oral vitamin D3 in critically ill vitamin D deficient patients: a randomized, double-blind, placebo-controlled pilot study

et al. 2011

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IntroductionVitamin D deficiency is encountered frequently in critically ill patients and might be harmful. Current nutrition guidelines recommend very low vitamin D doses. The objective of this trial was to evaluate the safety and efficacy of a single oral high-dose vitamin D3 supplementation in an intensive care setting over a one-week observation period.MethodsThis was a randomized, double-blind, placebo-controlled pilot study in a medical ICU at a tertiary care university center in Graz, Austria. Twenty-five patients (mean age 62 ± 16yrs) with vitamin D deficiency [25-hydroxyvitamin D (25(OH)D) ≤20 ng/ml] and an expected stay in the ICU >48 hours were included and randomly received either 540,000 IU (corresponding to 13.5 mg) of cholecalciferol (VITD) dissolved in 45 ml herbal oil or matched placebo (PBO) orally or via feeding tube.ResultsThe mean serum 25(OH)D increase in the intervention group was 25 ng/ml (range 1-47 ng/ml). The highest 25(OH)D level reached was 64 ng/ml, while two patients showed a small (7 ng/ml) or no response (1 ng/ml). Hypercalcemia or hypercalciuria did not occur in any patient. From day 0 to day 7, total serum calcium levels increased by 0.10 (PBO) and 0.15 mmol/L (VITD; P < 0.05 for both), while ionized calcium levels increased by 0.11 (PBO) and 0.05 mmol/L (VITD; P < 0.05 for both). Parathyroid hormone levels decreased by 19 and 28 pg/ml (PBO and VITD, ns) over the seven days, while 1,25(OH)D showed a transient significant increase in the VITD group only.ConclusionsThis pilot study shows that a single oral ultra-high dose of cholecalciferol corrects vitamin D deficiency within 2 days in most patients without causing adverse effects like hypercalcemia or hypercalciuria. Further research is needed to confirm our results and establish whether vitamin D supplementation can affect the clinical outcome of vitamin D deficient critically ill patients.EudraCT Number2009-012080-34German Clinical Trials Register (DRKS)DRKS00000750

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“…Reasons for hypocalcemia are not well understood, but besides elevated levels of IL-6, vitamin D deficiency may play a decisive role [31-34]. Without correction of vitamin D deficiency, calcium levels may be impossible to normalize [29].…”

Section: Introductionmentioning

confidence: 99%

Correction of vitamin D deficiency in critically ill patients - VITdAL@ICU study protocol of a double-blind, placebo-controlled randomized clinical trial

et al. 2012

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BackgroundVitamin D deficiency is associated with multiple adverse health outcomes including increased morbidity and mortality in the general population and in critically ill patients. However, no randomized controlled trial has evaluated so far whether treatment with sufficiently large doses of vitamin D can improve clinical outcome of patients in an intensive care setting.Methods/designThe VITdAL@ICU trial is an investigator-initiated, non-commercial, double-blind, placebo-controlled randomized clinical trial. This study compares high-dose oral cholecalciferol (vitamin D3) versus placebo treatment in a mixed population of 480 critically ill patients with low 25-hydroxyvitamin-D levels at study enrollment (≤ 20ng/ml). Following an initial loading dose of 540,000 IU of vitamin D3, patients receive 90,000 IU of vitamin D3 on a monthly basis for 5 months. The study is designed to compare clinical outcome in the two study arms with the primary endpoint being length of hospital stay. Secondary endpoints include among others length of ICU stay, the percentage of patients with 25(OH)D levels > 30 ng/ml at day 7, ICU and hospital mortality and duration of mechanical ventilation. We describe here the VITdAL@ICU study protocol for the primary report.DiscussionThis trial is designed to evaluate whether high-dose vitamin D3 is able to improve morbidity and mortality in a mixed population of adult critically ill patients and correct vitamin D deficiency safely.Trial registrationClinicalTrials: NCT01130181

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Transplant Recipients on the Edge of the Hypocalcemia Abyss

Cited by 10 publications

References 11 publications

Vitamin D Deficiency in Critically Ill Patients

Vitamin D Deficiency in Critically Ill Patients

Short-term effects of high-dose oral vitamin D3 in critically ill vitamin D deficient patients: a randomized, double-blind, placebo-controlled pilot study

Correction of vitamin D deficiency in critically ill patients - VITdAL@ICU study protocol of a double-blind, placebo-controlled randomized clinical trial

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