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KANTHARIA
M.D.
CONSULTING PHYSICIAN & CARDIOLOGIST CRITICAL CARE PHYSICIAN HON. PHYSICIAN: Saifee Hospital Sir. H.N. Hospital Smt. Motiben B. Dalvi Hospital
Mysteries of Vitamin D
What is Vitamin D
Is it Vitamin ? Is it Hormone ? Is it single molecule?
diet, vitamin D3 is stored in the liver, adipose tissue and muscle, where it has a half-life of about 60 days. It is converted into 25-hydroxyvitamin D3, 25 (OH)D in the hepatocytes , often called calcidiol. Once converted to calcidiol, there appears to be no difference in their biologic activity
1,25(OH)2D Calcitriol.
Although there are more than 40 vitamin D
metabolites identified, the predominate effects of vitamin D in the body are exerted through the actions of 1,25(OH)2D (calcitriol).
What do we measure ?
What do we measure ?
Most assays for 25(OH)D cannot differentiate the two
distinct forms, 25(OH) D2 from 25(OH) D3, so the abbreviation 25(OH)D is used.
What do we measure ?
The serum 25-hydroxyvitamin D , 25(OH)D level is the
best indicator of overall vitamin D status because this measurement reflects total vitamin D from dietary intake and sunlight exposure, as well as the conversion of vitamin D from adipose stores in the liver
Source of Vitamin D
(1) Sunlight
The skin synthesizes vitamin D3 from
7-dehydrocholesterol in response to ultraviolet B radiation in sunlight. This synthetic process depends on many factors, including latitude, altitude, time of year and day, weather, age, skin pigmentation type, clothing, activity and other aspects of the environment.
12 PM EST an individual with type III skin, with 25.5% of the body surface area exposed, would need to spend 3 to 8 minutes in the sun to synthesize 400 IU of vitamin D.
recommend intentional sun exposure based on our findings, it is difficult, if not impossible to titrate ones exposure. There are well-known detrimental side effects of ultraviolet irradiation. Therefore, oral supplementation remains the safest way for increasing vitamin D status. ( J Am Acad Dermatol 2010;62:929.e1-e9.)
Source of Vitamin D
(2) Diet :
Deficiency.. Why ??
Vitamin D In CKD
57
14
58
26
Adapted from LaClair RE, Hellman RN, Karp SL, et al: Prevalence of calcidiol deficiency in CKD: a cross-sectional study across latitudes in the United States. Am J Kidney Dis 45:10261033, 2005.
Vitamin D in Myalgia
whether low serum 25 (OH) vitamin D (D2 + D3) (<32 ng/mL) was associated with myalgia in statin-treated patients and whether the myalgia could be reversed by vitamin D supplementation while continuing statins.
while continuing statins, 38 were given vitamin D (50,000 units/week for 12 weeks), with a resultant increase in serum vitamin D from 20.4 to 48.2 ng/mL (P , 0.0001) and resolution of myalgia in 35 (92%).
Recommended dosage
Recommended dosage
In healthy adults at low risk for vitamin D deficiency
(i.e., under age 50, without osteoporosis or conditions affecting vitamin D absorption or action), routine vitamin D supplementation (1025 g [4001000 IU] daily) is recommended.
Recommended dosage
Adults over 50 years of age who are at moderate risk for
vitamin D deficiency. Supplementation with at least 2025 g (8001000 IU) of vitamin D3 daily is recommended. To achieve optimal vitamin D status (> 75 nmol/L), many individuals may require supplementation at greater than 25 g (1000 IU) daily
Recommended dosage
Doses up to 50 g (2000 IU) per day are safe and do
Recommended dosage
Treatment of severe deficiency (rickets or
osteomalacia) requires higher doses, e.g., 1250 g (50 000 IU) daily for two to four weeks, then weekly or biweekly, with monitoring of serum 25hydroxyvitamin D at one and three months.
potential to cause progressive accumulation and toxic effects, presenting as hypercalcemia and renal damage.
Toxic effects occur only with prolonged (at least several
Conclusion
Sunlight is inadequate source of Vitamin D
Diet is inadequate source of Vitamin D Diet fortified with Vit D is required. Calcium and Vitamin D are coprescribed Vitamin D supplementation is essential and that too in