vitamin%20d%20deficiency
VITAMIN D DEFICIENCY

Vitamin D deficiency is a condition wherein there is low circulating levels of vitamin D. Vitamin D is an essential steroid hormone found in the body.

It results from inadequate sunlight exposure, malabsorptions &/or inadequate nutrition.

Vitamin D insufficiency is a less severe state of calcidiol deficiency and associated w/ parathyroid hormones and osteoporosis.

 

Vitamin%20d%20deficiency Management

Prevention

  • Adequate sun exposure between 10:00 AM and 3:00 PM but should be done with caution in children ≤6 months
  • Fortification of food with vitamin D2 or D3
  • Vitamin D supplementation would help to prevent osteomalacia/rickets due to vitamin D deficiency
    • 1-12 months and exclusively breastfed infants - at least 400 IU/day
    • 1 -70 years old - 600 IU/day
    • ≥70 years old - 800 IU/day
    • In pregnant or lactating women, obese person, and on patients on anticonvulsants, steroid, antifungals and antiretroviral medication, should receive 2-3 times higher dose
  • Children with increased risk of vitamin D deficiency (eg chronic fat malabsorption, chronic intake of anticonvulsants) may be given higher doses of vitamin D supplementation wtih 25-OH-D level monitoring every 3 months and PTH and bone-mineral status monitoring every 6 months until normal levels have been achieved
  • Idiopathic infantile hypercalcemia may be triggered in infants receiving 600 IU bolus every 3 months
    • Attributed to mutation in CYP24A1
    • Manifests as dehydration, failure to thrive, hypercalcemia, nephrocalcinosis and vomiting
  • Most bone and mineral problems are prevented by 50,000 units of ergocalciferol given once monthly
  • Larger doses should be given in patients who underwent bypass surgery for obesity, celiac disease, gastric surgery
  • If osteomalacia is due to hypophosphatemia, lifelong phosphorus supplementation is needed
  • Increase in calcium-rich diet has been shown to increase serum 25(OH)D and decrease serum 1,25 (OH)2D concentration
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