Use of a Loading Dose of Vitamin D for Treatment of Vitamin D Deficiency in Patients With Intestinal Failure

Grenade, Neil; Kosar, Christina; Steinberg, Karen K.; Avitzur, Yaron; Wales, Paul W.; Courtney‐Martin, Glenda

doi:10.1177/0148607115625220

Cited by 12 publications

(15 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previously, 10%–20% of patients with intestinal failure were reported to require daily oral vitamin D 3 at a dosage of 5,000–6,000 IU. Additionally, a smaller number of patients still do not respond to a high amount of vitamin D 3 [ 11 ]. Grenade et al [ 11 ] reported that a loading dosage of 20,000–40,000 IU of vitamin D 3 once a week, with a daily maintenance dosage of 4,000–6,000 IU/day on the remaining 6 days, has shown efficiency in improving the vitamin D level of 3 patients with intestinal failure.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, a smaller number of patients still do not respond to a high amount of vitamin D 3 [ 11 ]. Grenade et al [ 11 ] reported that a loading dosage of 20,000–40,000 IU of vitamin D 3 once a week, with a daily maintenance dosage of 4,000–6,000 IU/day on the remaining 6 days, has shown efficiency in improving the vitamin D level of 3 patients with intestinal failure. A prospective study with 40 infants and toddlers in Qatar reported that parenteral injection of a megadose (10,000 IU/kg) of vitamin D3 for 3 months normalized all the laboratory findings and radiological manifestations [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…11) Enteral supplementation of vitamin D was inefficient in patients with vitamin D deficiency caused by intestinal malabsorption, such as cystic fibrosis, short bowel syndrome, inflammatory bowel disease, and intestinal accessory organ dysfunction. 11,12) In these cases, parenteral supplementation of vitamin D is a promising alternative strategy. 10) Therefore, this study was performed to investigate the efficacy and safety of parenteral vitamin D supplementation in infants and children with vitamin D deficiency caused by intestinal malabsorption.…”

Section: Efficacy and Safety Of Parenteral Vitamin D Therapy In Infanmentioning

confidence: 99%

“…Intestinal absorption of vitamin D occurs primarily in the jejunum and ileum [ 10 ]. Vitamin D deficiency is recognized as the most prevalent nutrient deficiency in patients with intestinal failure [ 11 ]. Enteral supplementation of vitamin D was inefficient in patients with vitamin D deficiency caused by intestinal malabsorption, such as cystic fibrosis, short bowel syndrome, inflammatory bowel disease, and intestinal accessory organ dysfunction [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…Vitamin D deficiency is recognized as the most prevalent nutrient deficiency in patients with intestinal failure [ 11 ]. Enteral supplementation of vitamin D was inefficient in patients with vitamin D deficiency caused by intestinal malabsorption, such as cystic fibrosis, short bowel syndrome, inflammatory bowel disease, and intestinal accessory organ dysfunction [ 11 , 12 ]. In these cases, parenteral supplementation of vitamin D is a promising alternative strategy [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Efficacy and safety of parenteral vitamin D therapy in infants and children with vitamin D deficiency caused by intestinal malabsorption

Lee

et al. 2020

Ann Pediatr Endocrinol Metab

View full text Add to dashboard Cite

Oral supplementation of vitamin D can be inefficient in patients with vitamin D deficiency caused by intestinal malabsorption. This study investigated the efficacy and safety of parenteral vitamin D supplementation in infants and children with vitamin D deficiency caused by intestinal malabsorption. Methods: This study included 11 patients with vitamin D deficiency who were unresponsive to oral vitamin D or were unable to try oral vitamin D therapy due to underlying conditions. All patients were treated with weekly intramuscular injection of cholecalciferol 50,000 IU. Radiological findings and biochemical parameters including serum calcium, phosphorus, alkaline phosphatase, 25-hydroxyvitamin D3 (25(OH)D3), and parathyroid hormone levels were reviewed retrospectively. Results: Underlying diseases included small bowel atresia (n=3), necrotizing enterocolitis (n=3), congenital megacolon (n=2), chronic intestinal pseudoobstruction (n=1), congenital mesenteric band (n=1), and Crohn disease (n=1). Three patients exhibited rickets on X-ray findings. The mean duration of treatment was 4.8±2.9 weeks. The alkaline phosphatase levels were decreased from 710±650 IU/L to 442±284 IU/L (P=0.143). The 25(OH)D3 level was increased from 6.0±3.4 ng/ mL to 50.4±28.8 ng/mL (P=0.008) after 3 months. Two patients with rickets showed improved radiologic findings after parenteral treatment. Conclusion: Parenteral vitamin D therapy was effective and safe in patients with vitamin D deficiency caused by intestinal malabsorption. Long-term follow-up is needed to establish the efficacy of parenteral vitamin D therapy in a large number of patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Efficacy and Safety Of Parenteral Vitamin D Therapy In Infanmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Efficacy and safety of parenteral vitamin D therapy in infants and children with vitamin D deficiency caused by intestinal malabsorption

Lee

et al. 2020

Ann Pediatr Endocrinol Metab

View full text Add to dashboard Cite

show abstract

Should Clinicians Prescribe Non-FDA Regulated Dietary Supplements When Caring for Children With Hypovitaminosis D?

Mezoff

Hays

Shaikhkhalil

2022

AMA Journal of Ethics

View full text Add to dashboard Cite

Hypovitaminosis D is a prevalent micronutrient deficiency that can be severe and hard to treat in children with short bowel syndrome, a condition treated with substantial bowel resection. Surgically altered bowel anatomy then results in iatrogenic digestion and absorption limitations that require short-and long-term management and follow-up. Care of children with hypovitaminosis D standardly includes prescription dietary micronutrient supplementation, sometimes in irregularly high doses. This commentary responds to a pediatric case of vitamin D toxicity and suggests micronutrient-prescribing risk mitigation strategies in light of the absence of regulatory oversight of over-the-counter dietary supplements, inadequate insurance coverage, and easily available commercial retail products.Case MP is a teenage girl with short bowel syndrome (SBS) related to gastroschisis, initially leaving her with approximately 10 centimeters of small bowel in continuity with her descending colon. Following multiple autologous intestinal reconstructive surgeries performed to address clinically relevant bowel dilation, her small bowel length was measured at 73 centimeters. Her clinical course has been complicated by intestinal failure-associated liver disease, recurrent small bowel bacterial overgrowth, limited vascular access related to thrombosis that requires anticoagulation, and multiple central line-associated bloodstream infections prior to central line removal. She achieved enteral autonomy with line removal at age 10 years.

show abstract

Vitamin D status in children with intestinal failure who have achieved enteral autonomy

et al. 2021

View full text Add to dashboard Cite

Background: Vitamin D deficiency is highly prevalent in children with intestinal failure (IF) who receive parenteral nutrition (PN), but data on vitamin D status after achieving enteral autonomy (EA) are limited. We aimed to evaluate the prevalence of vitamin D deficiency in this population while exploring clinical variables that may be associated with its development. Methods: A retrospective review was performed on 29 children with IF who had achieved EA. Deficiency was defined as a mean serum 25-hydroxyvitamin D <30 ng/ml. Data Results: Sixty-six percent of children had at least one deficient level during the study period, with 38% being deficient based on the mean vitamin D levels.Eighty-four percent had radiologic evidence of osteopenia. Compared with the sufficient group (n=18), the deficient group (n=11) received higher daily mean vitamin D doses (2246 vs 920 IU; P=.02), had shorter remnant small-bowel length (53.8 vs 82.1 cm; P=.03), and were PN dependent for a longer duration (1.3 vs 0.58 years; P=.01). Univariate analyses revealed longer remnant gut length (odds ratio [OR] = 1.03; P=.04) and shorter duration of PN (OR = 0.26; P=.04) to be significantly associated with sufficient vitamin D status. Conclusion:Vitamin D deficiency and osteopenia are highly prevalent in pediatric patients with a history of IF who have achieved EA, despite enteral supplementation with higher than standard doses. Shorter remnant small-bowel length and longer duration of PN were associated with vitamin D deficiency. These findings emphasize the importance of prolonged surveillance and highlight the need for alternate dosing regimens.

show abstract

Use of a Loading Dose of Vitamin D for Treatment of Vitamin D Deficiency in Patients With Intestinal Failure

Cited by 12 publications

References 19 publications

Efficacy and safety of parenteral vitamin D therapy in infants and children with vitamin D deficiency caused by intestinal malabsorption

Efficacy and safety of parenteral vitamin D therapy in infants and children with vitamin D deficiency caused by intestinal malabsorption

Should Clinicians Prescribe Non-FDA Regulated Dietary Supplements When Caring for Children With Hypovitaminosis D?

Vitamin D status in children with intestinal failure who have achieved enteral autonomy

Contact Info

Product

Resources

About