Indications: Vitamin D Supplementation or Replacement Contraindications: Vitamin D Supplementation Preparations: Dietary and Supplement Sources Signs: Vitamin D Deficiency Signs: Vitamin D Toxicity (related to Hypercalcemia) Dosing (higher than current RDA) Dosing: Supplementation in Infants and Children under age 2 years Dosing: Children with Vitamin D Deficiency (Rickets) Dosing: Adults with Vitamin D Deficiency Efficacy: Vitamin D in Osteoporosis Prevention Extra: Related Bing Images Step 1a: Start with 7-DehydrocholesterolSkin exposure to sunlight or other ultraviolet light (290-315 nm of UV-B radiation)This pathway represents 90% of Vitamin D synthesis in humans Step 1b: Start with Dietary Vitamin D2 or D3Proceed to step 2 (bypasses sunlight-mediated synthesis pathway)Typically represents only 10% of Vitamin D source (unless specifically supplemented) Step 2: Cholecalciferol (Vitamin D3)Metabolized in liver by Vitamin D3-25 hydroxylase
Step 3: CalcidiolMetabolized in Kidney by 25-OH-D3-1a hydroxylase Step 4: Calcitriol (active form of Vitamin D) See Serum Calcium for calcium metabolism SourcesVitamin D synthesized in skin after exposed to sunAbsorbed from Small Intestine Vitamin D circulates in blood as Calcidiol Vitamin D Deficiency seen in:Homebound elderlyInhabitants of Northern States Vitamin D Deficiency related conditionsChildren: RicketsAdults: Osteoporosis IV. Indications: Vitamin D Supplementation or Replacement V. Contraindications: Vitamin D Supplementation Granulomatous disease (e.g. Tuberculosis, Sarcoidosis) VI. Preparations: Dietary and Supplement Sources Fish (Vitamin D3, most in fatty fish)Salmon (450 IU per 3 oz)SardinesFish oilsTuna (150 IU per 3 oz) Liver and other organ meats Vitamin D Fortified Milk (USA) contains 100 IU per cup Multi-Vitamin Contains 400 IU Vitamin D per tablet VII. Signs: Vitamin D Deficiency See Vitamin D Deficiency
VIII. Signs: Vitamin D Toxicity (related to Hypercalcemia) Vascular calcinosis or nephrocalcinosis IX. Dosing (higher than current RDA) Children and Adolescents: 400 IU per day Adults Age 18-50 years: 400-800 IU per day Adults Age >50 years or Osteoporosis:Southern regions: 800-2000 IU per dayNorthern climates: 2000 IU per day may be required Expect a 0.4 ng/ml increase for every 40 IU daily of Vitamin DExpect 4 ng/ml increase from 400 IU dailyExpect 40 ng/ml increase from 4000 IU daily Vitamin D is fat soluble and is best absorbed with fat in the meal X. Dosing: Supplementation in Infants and Children under age 2 years IndicationsSee Vitamin D Deficiency for risk factorsBreastfed InfantsChildren and adolescents consuming <1 Liter (34 oz) Vitamin D Fortified milk daily Supplements with daily dose of 1 drop (equivalent to 400 IU) for age under 2 yearsCarlson Baby D Drops Supplements with daily dose of 1 ml (equivalent to 400 IU) for age under 2 yearsEnfamil Poly-Vi-Sol Multivitamin Supplement dropsEnfamil Poly-Vi-Sol Vitamins A, C and D with IronSunlight Vitamins Just D Infant Vitamin DropsTwinlab Infant Care Multivitamin Drops with DHA
ReferencesCasey (2010) Am Fam Physician 81(6): 745-50 [PubMed] XI. Dosing: Children with Vitamin D Deficiency (Rickets) Ergocalciferol (D2, Calciferol)Dose: 25-125 mcg (1-5000 IU) PO/IM for 6-12 weeks Cholecalciferol (D3, 40,000 IU/mg)Option 1: 125-250 mcg (5-10,000 IU) PO for 3 monthsOption 2: 15,000 mcg (600,000 IU) divided qid x1 day Dihydrotachysterol (DHT, 120,000 IU/mg)Option 1: 500 mcg (0.5 mg) for single dose orOption 2: 13-50 mcg PO per day until resolved ReferencesKhatib (2005) Consultant Pediatrician 4:33-9 [PubMed] XII. Dosing: Adults with Vitamin D Deficiency Mild (Serum 25-hydroxyvitamin D 8-15 ng/ml)Calcium 1200 to 1500 mg orally dailyVitamin DOption 1: Vitamin D 50,000 IU PO weekly for 8 weeks (repeat another course if Vitamin D <30 ng/ml)Option 2: Vitamin D 1000 IU daily per every 10 ng/ml shortfall in addition to maintenance for 6 weeksExample: Vitamin D 10 ng/ml - take 2000 IU replacement in addition to 1000 IU maintenance dailyOption 3
: Vitamin D 20-25 IU/kg IV daily (parenteral for hospitalized patients)Maintenance after acute replacement: Vitamin D 800-1000 IU PO daily Severe (Serum 25-hydroxyvitamin D <8 ng/ml)Vitamin D 50,000 IU orally daily for 1-3 weeksThen maintain as mild deficiency doses above Monitoring Vitamin D level at 6-8 weeks after starting therapyGoal 25-Hydroxyvitamin D >30-40 ng/mlStorage of Vitamin D does not start until 40 ng/ml XIII. Efficacy: Vitamin D in Osteoporosis Prevention Dutch Study of 348 women over age 70 yearsGiven Vitamin D 400 IU or PlaceboVitamin D Group had greater BMD at 2 yearsGreater femoral neck Bone Mineral DensityPlacebo group had decreased Bone Mineral DensityNo change in femoral trachanter or distal radius BMD ReferencesOoms (1995) J Clin Endocrinol Metab 80:1052-8 [PubMed] Holick (2007) N Engl J Med. 357(3):266-81 [PubMed] Schneider (2006) Curr Opin Endocrinol Diabetes 13(6): 483-90 [PubMed] Norman (2007) J Steroid Biochem Mol Biol 103(3):204-5 [PubMed]
Images: Related links to external sites (from Bing) Related Studies (from Trip Database) Open in New Window , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , LP31696-5, LP15553-8, MTHU010601, LA18889-8 , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , Vitamin D helps your body absorb calcium, which your bones need to grow. A lack of vitamin D can lead to bone diseases such as osteoporosis or rickets. Vitamin D also has a role in your nerve, muscle, and immune systems. You can get vitamin D in three ways: through your skin, from your diet, and from supplements. Your body forms Vitamin D naturally after exposure to sunlight. However, too much sun exposure can lead to skin aging and skin cancer. So many people try to get their vitamin D from other sources. Vitamin D-rich foods include egg yolks, saltwater fish, and liver.