Outpatient / Endocrinology
Vitamin D Deficiency
# Vitamin D Deficiency
History: *** (osteoporosis, falls,
Etiology: *** (hyperPTH, lack of sunlight, alcohol, malabsorption from IBD, celiac, gastrectomy, impaired synthesis from CKD or ESLD, drugs (steroids, AED both increase metabolism of VitD)
Plan
- f/u Calcium, PTH, CMP, Phos
- 25(OH)D <12 - load 50,000 U cholecalciferol weekly for 8 weeks, then 800-1000 units daily
- 25(OH)D 12-20 - 1000-2000 units cholecalciferol daily
- 25(OH)D 20-30 - 600-800 units cholecalciferol daily
- f/u repeat level in 3-4 months
Template coming soon!
Patient Guidance and Information
New Diagnosis of Vitamin D Deficiency
Based on your recent lab results, you have been diagnosed with a vitamin D deficiency. Vitamin D is essential for maintaining healthy bones and supporting your immune system. Your body naturally produces vitamin D when exposed to sunlight, but it can also be obtained through certain foods and supplements.
I recommend taking a vitamin D supplement called ***. Please take *** with food. We can plan to follow up your Vitamin D levels in 3-4 months.
Additionally, consider spending more time outdoors in sunlight and incorporating vitamin D-rich foods, such as fatty fish and dairy products, into your diet.
If You Remember Nothing Else
Vitamin D should be supplemented when 25(OH)D (calcidiol - the strorage form) is less than 20-30. You should supplement with D3 (cholecalciferol) instead of D2 (ergocalciferol).
Clinical Pearls
- No regular screening - send if fractures, calcium disorders, hyperPTH
- Send 25(OH)D - calcidiol (storage form, long half-life)
- Vitamin D - 25(OH)D is calcidiol which is the storage form used to assess for insufficiency; 1,25(OH)D is the active form
- Vitamin D2 (ergocalciferol) comes from plant sources; D3 (cholecalciferol) is formed in skin and comes from animal sources and is more effective at raising levels when supplemented and is thus preferred; difference is at the level of liver metabolism
- It is very hard to get Vitamin D from diet so if you can’t get from sun will have to supplement
- It is very hard to get too much Vitamin D to the point of toxicity - pretty much always okay to supplement
- Liver hydroxylates calecalciefrol (D3) to calcidiol which is again hydroxylated in kidney to active form of 1,25(OH)D
- Higher likelihood of VitD deficiency in those with heavily pigmented skin - more UV absorbed by melanin, lower rates of VitD synthesis
- Breastmilk is low in VitD, so infants <1 exclusively breast fed should be supplemented
- Breastmilk is low in VitD, so infants <1 exclusively breast fed should be supplemented
- Cholecalciferol (D3) synthesized in stratum basale when exposed to UV light
- 1-alpha hydroxylase in kidney is regulated by calcium, phosphate, PTH levels
- Vitamin D leads to increased absorption of calcium and phosphate in intestines and stimulates bone mineralization
Trials and Literature
- Review of Vitamin D Deficiency in NEJM
Other Resources
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