Acute fluid shifts influence the assessment of serum vitamin D status in critically ill patients

Krishnan, A, Ochola, J, Mundy, J, Jones, M, Kruger, P, Duncan, E and Venkatesh, B (2010) Acute fluid shifts influence the assessment of serum vitamin D status in critically ill patients. Critical Care, 14 6: R216-1-R216-7.


Author Krishnan, A
Ochola, J
Mundy, J
Jones, M
Kruger, P
Duncan, E
Venkatesh, B
Title Acute fluid shifts influence the assessment of serum vitamin D status in critically ill patients
Journal name Critical Care  (ERA 2012 Listed)    (ERA 2010 Rank A)   Check publisher's open access policy
Publication date 2010-11-26
Sub-type Article
DOI 10.1186/cc9341
Volume number 14
Issue number 6
ISSN 1466-609X
Start page R216-1
End page R216-7
Total pages 7
Place of publication London, United Kingdom
Publisher BioMed Central
Collection year 2011
Language eng
Formatted abstract Introduction:
Recent reports have highlighted the prevalence of vitamin D deficiency and suggested an association with excess mortality in critically ill patients. Serum vitamin D concentrations in these studies were measured following resuscitation. It is unclear whether aggressive fluid resuscitation independently influences serum vitamin D.

Methods:
Nineteen patients undergoing cardiopulmonary bypass were studied. Serum 25(OH)D3, 1α,25(OH)2D3, parathyroid hormone, C-reactive protein (CRP), and ionised calcium were measured at five defined timepoints: T1 - baseline, T2 - 5 minutes after onset of cardiopulmonary bypass (CPB) (time of maximal fluid effect), T3 - on return to the intensive care unit, T4 - 24 hrs after surgery and T5 - 5 days after surgery. Linear mixed models were used to compare measures at T2-T5 with baseline measures.

Results:
Acute fluid loading resulted in a 35% reduction in 25(OH)D3 (59 ± 16 to 38 ± 14 nmol/L, P < 0.0001) and a 45% reduction in 1α,25(OH)2D3 (99 ± 40 to 54 ± 22 pmol/L P < 0.0001) and i(Ca) (P < 0.01), with elevation in parathyroid hormone (P < 0.0001). Serum 25(OH)D3 returned to baseline only at T5 while 1α,25(OH)2D3 demonstrated an overshoot above baseline at T5 (P < 0.0001). There was a delayed rise in CRP at T4 and T5; this was not associated with a reduction in vitamin D levels at these time points.

Conclusions:
Hemodilution significantly lowers serum 25(OH)D3 and 1α,25(OH)2D3, which may take up to 24 hours to resolve. Moreover, delayed overshoot of 1α,25(OH)2D3 needs consideration. We urge caution in interpreting serum vitamin D in critically ill patients in the context of major resuscitation, and would advocate repeating the measurement once the effects of the resuscitation have abated.
© 1999-2011 BioMed Central Ltd
Keyword Cardiopulmonary bypass
Protein blood level
Critically ill patient
Cardiopulmonary bypass
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published under Research. Article number R216. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Document type: Journal Article
Sub-type: Article
Collections: Official 2011 Collection
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Created: Wed, 16 Mar 2011, 12:29:42 EST by Sharleen Young on behalf of School of Medicine