A randomized study of a single dose of intramuscular cholecalciferol in critically ill adults

Nair, Priya, Venkatesh, Bala, Lee, Paul, Kerr, Stephen, Hoechter, Dominik J., Dimeski, Goce, Grice, Jeffrey, Myburgh, John and Center, Jacqueline R. (2015) A randomized study of a single dose of intramuscular cholecalciferol in critically ill adults. Critical Care Medicine, 43 11: 2313-2320. doi:10.1097/CCM.0000000000001201

Author Nair, Priya
Venkatesh, Bala
Lee, Paul
Kerr, Stephen
Hoechter, Dominik J.
Dimeski, Goce
Grice, Jeffrey
Myburgh, John
Center, Jacqueline R.
Title A randomized study of a single dose of intramuscular cholecalciferol in critically ill adults
Journal name Critical Care Medicine   Check publisher's open access policy
ISSN 1530-0293
Publication date 2015-01-01
Sub-type Article (original research)
DOI 10.1097/CCM.0000000000001201
Open Access Status Not Open Access
Volume 43
Issue 11
Start page 2313
End page 2320
Total pages 8
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams and Wilkins
Language eng
Formatted 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.
Keyword Calcium
Critical Illness
Hyperparathyroidism secondary
Inflammatory markers
Vitamin D
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
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