A Randomized Study of a Single Dose of Intramuscular Cholecalciferol in Critically Ill Adults. Issue 11 (November 2015)

• Record Type: Journal Article
• Authors: Nair, Priya; Venkatesh, Bala; Lee, Paul; Kerr, Stephen; Hoechter, Dominik J.; Dimeski, Goce; Grice, Jeffrey; Myburgh, John; Center, Jacqueline R.
• Is Part Of: Critical care medicine. Volume 43:Issue 11(2015)
• Publication Date: 2015-11
• Subjects: calcium -- cholecalciferol -- critical illness -- hyperparathyroidism secondary -- inflammatory markers -- vitamin D; Critical care medicine -- Periodicals; Soins intensifs -- Périodiques; 616.028
• DOI: 10.1097/CCM.0000000000001201
• Languages: English
• ISSNs: 0090-3493

Abstract

Abstract : Objectives: To determine the effect of two doses of intramuscular cholecalciferol on serial serum 25-hydroxy-vitamin-D levels and on pharmacodynamics endpoints: calcium, phosphate, parathyroid hormone, C-reactive protein, interleukin-6, and cathelicidin in critically ill adults. Design: Prospective randomized interventional study. Setting: Tertiary, academic adult ICU. Patients: Fifty critically ill adults with the systemic inflammatory response syndrome. Intervention: Patients were randomly allocated to receive a single intramuscular dose of either 150, 000 IU (0.15 mU) or 300, 000 IU (0.3 mU) cholecalciferol. Measurements and Main Results: Pharmacokinetic, pharmacodynamic parameters, and outcome measures were collected over a 14-day period or until ICU discharge, whichever was earlier. Prior to randomization, 28 of 50 patients (56%) were classified as vitamin D deficient. By day 7 after randomization, 15 of 23 (65%) and 14 of 21 patients (67%) normalized vitamin D levels with 0.15 and 0.3 mU, respectively ( p = 0.01) and by day 14, 8 of 10 (80%) and 10 of 12 patients (83%) ( p = 0.004), respectively. Secondary hyperparathyroidism was manifested in 28% of patients at baseline. Parathyroid hormone levels decreased over the study period with patients achieving vitamin D sufficiency at day 7 having significantly lower parathyroid hormone levels ( p < 0.01). Inflammatory markers (C-reactive protein and interleukin-6) fell significantly over the study period. Greater increments in 25-hydroxy-vitamin-D were significantly associated with greater increments in cathelicidin at days 1 and 3 ( p = 0.04 and 0.004, respectively). Although in-hospital mortality rate did not differ between the groups, patients who did not mount a parathyroid hormone response to vitamin D deficiency had a higher mortality (35% vs 12%; p = 0.05). No significant adverse effects were observed. Conclusions: A single dose of either dose of intramuscular cholecalciferol corrected vitamin D deficiency in the majority of critically ill patients. Greater vitamin D increments were associated with early greater cathelicidin increases, suggesting a possible mechanism of vitamin D supplementation in inducing bactericidal pleiotropic effects.