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Why don’t they give vitamin D in intensive care units?

Posted on: July 18, 2011   by  John Cannell, MD

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Dear Dr. Cannell,

Why don’t they give vitamin D in the ICU in the hospital? I think they know it will hurt their business.

Jeff, California

 

Dear Jeff,

When I was young, I always suspected conspiracy. As I grow older, I see that it is usually incompetence. Things are beginning to change. For example, several months ago the journal Critical Care had just the kind of study you are implying the system will not do. They gave 540,000 IU to ten patients near death in an ICU. They gave it via a feeding tube and then compared those patients to ten patients given a placebo. They found that 540,000 IU as a single dose will achieve levels of around 40 ng/ml, but it takes three days to do so (the patients started with levels of around 12 ng/ml).

Amrein K, et al. Short-term effects of high-dose oral vitamin D3 in critically ill vitamin D deficient patients: a randomized, double-blind, placebo-controlled pilot study. Crit Care. 2011 Mar 28; 15(2): R104

The overall death rate between the two groups was the same, 50%, but vitamin D patients who still had low blood calcium (common in an ICU) at day three were three times more likely to die than those who obtained normal blood calcium, but the numbers were not large enough for significance. However, the findings suggest that doctors need to give it earlier and give it either intramuscularly or intravenously. Larger doses probably won’t help as the body can’t deal with that much. I predict that eventually vitamin D will be available as an IV and that the most useful preparation will be intravenous 25(OH)D. Oral 25(OH)D was taken off the market several years ago, before the vitamin D revolution began.

1 Response to Why don’t they give vitamin D in intensive care units?

  1. rkcannon@yahoo.com

    There is a similar situation for magnesium in ICUs. Many are low, causing longer ventilation, sepsis, recovery in general. Google mg and sepsis for more info. Mg and D seem very closely related.

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