The patient had been treated with Intravenous fluids, diuretics, and calcitonin. Two weeks later, the patient’s symptoms had gradually improved and had been discharged with normal serum calcium and creatinine.
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The pt should be advised no to take OCT medications, including nutritional vitamin D, good hydration, continue out patient follow up with S.Ca and 25(OH)D levels
Vitamin D status is measured by 25(OH)D level as it reflects body stores with longer 1/2 life, but the bioactive form 1,25(OH)2D with short 1/2 life is of value in granulomatous diseases where it will show high value despite normal/reduced 25(OH)D.
1- good hydration, to avoid over encounter medication without prescription
check vitamin D every 3-6 months
2- 25OH D level for vitamin D deficiency
1,25 specific for some disease like sarcoidosis
The patient should maintain good hydration, avoid nephrotoxic drugs, and keep off vit D for now. He will need to check the 25 OH Vit D3 level in 3 months. If the level is normal, he can only resume the Daily recommended dose of vit D 600 iu daily, preferably through food.
25 (OH)Vit D is usually the recommended testing for the general population as it has a longer half-life. 1-25 OH Vit D (has short half life) measures the active form Vit D3 and needs to be tested when the conversion from Vit D3 to 1-25 OH vit D increases, such as in granulomatous diseases.
1 stop vitamin D
diet
patient should obtain good hydration and stop over the counter buying of vitamin d supplement ,
Appraise the rationale of serum 25(OH)D3& 1,25(OH) D3 assay in assessment of vit D status.
although the 1,25(OH) D3 is the biological active form of vitamin d it can not be the ideal measurement for vitamin d status .the reason is the circulating of1,25(OH)D the half life is only 4-6hrs .the circulating 1,25(OH)D are much less than 25(OH)D, when patient is vitamin d deficiency there is a decline in intestinal calcium absorption .
1- stop over the counter medications containing excess vit D , good oral hydration
Suggest a long-term management plan for this patient.
Appraise the rationale of serum 25(OH)D3& 1,25(OH) D3 assay in assessment of vit D status
1.Suggest a long-term management plan for this patient.
Discontinue or decrease dose of high vitamin D supplements.
To ingest vitamin D naturally, you can eat foods that are rich in it, including:
cod liver oil, fatty fish, such as salmon and tuna, beef liver, cheese, egg yolks.
2. Appraise the rationale of serum 25(OH)D3& 1,25(OH) D3 assay in assessment of vit D status.
Serum 25(OH)D is the barometer for vitamin D status.
Direct serum detection of 1,25(OH)2D is unlikely to occur, because a sample pre-purification will always be required.
The circulating half-life of circulating 1,25(OH)D is only 4-6 hours. Circulating levels of 1,25(OH)D are a thousand-fold less than 25(OH)D. As a patient becomes vitamin D deficient, there is a decrease in intestinal calcium absorption which lowers ionized calcium transiently. This signal is recognized by the calcium sensor in the parathyroid glands to increase the production and secretion of parathyroid hormone (PTH). PTH regulates calcium metabolism by increasing tubular reabsorption of calcium in the kidney, increasing mobilization of calcium from the skeleton and by increasing the renal production of 1,25(OH)D. Thus, if the patient becomes vitamin D insufficient and deficient, the increase in PTH levels results in normal or elevated serum 1,25 (OH)D.
Suggest a long-term management plan for this patient: patient education and counselling
Appraise the rationale of serum 25(OH)D3& 1,25(OH) D3 assay in assessment of vit D status
25[OH]D3:is the major circulating form of vitamin D.half-life of two to three weeks. It has activity at bone and intestine but is less than 1% as potent as 1,25-dihydroxyvitamin D, the most active form of vitamin D.
1,25(OH) D3:The half-life is approximately four to six hours. 25[OH]D3 is recommended for measuring the status of vit D level in the all population.
Dietary education
stop any vit D supplementation
frequent monitoring of serum calcium and vit D 25 level.
Serum 25(oH)D3 represent total storage in the body and used for measurement of vit D status. long half life .
1,25(OH)D3 short half-life, reflect kidney function,more expensive.
1-long term management
Stop vit D intake avoid unnecessary multivitamin intake good hydration regular check serum pth ca po4 and follow up renal function with avoidance any nephritoxic madications
2- the rational is vit D is rapidly converted to 25(OH)D, but in serum only a fraction of 25(OH)D is converted to its active metabolite 1,25(OH)2D. Thus, measurement of the total 25(OH)D level is the best test to assess body stores vit D
Long-term plan:
25(OH)D vs 1,25(OH)2D:
Stop the Vitamin D.
Good hydration.
Re-education about the risk of Vitamin D intoxication.
2. Appraise the rationale of serum 25(OH)D3& 1,25(OH) D3 assay in assessment of vit D status.
Vitamin D is rapidly converted to 25(OH)D, but in serum only a fraction of 25(OH)D is converted to its active metabolite 1,25(OH)2D. Thus, measurement of the total 25(OH)D level is the best test to assess body stores of vitamin D
PATIENT NOT NEEDS FOR ANY FURTHER PLANS ONLY EDUCATION REGARDING DIET AND VIT D INTAKE AND ALSO LAB TESTS FOR VIT D CALCIUM AND KFT
1 dietary advice, encourage excessive fluid intake, stop vitamin D supplements
Monitor s. Ca, 25 OH vitamin D3
2. The level of 1,25 Dihydr. Vit D will decrease when progressive decrease in GFR.
25 OH vitamin D reflect the storage.
Suggest a long-term management plan for this patient.
Appraise the rationale of serum 25(OH)D3& 1,25(OH) D3 assay in assessment of vit D status
25[OH]D3:
1,25(OH) D3:
25[OH]D3 is recommended for measuring the status of vitD level in the all population.
Long-term management plan
The rationale of serum 25(OH)D3& 1,25(OH) D3 assay in assessment of vit D status
follow up his renal function as he suffered from AKI which is a risk factor for CKD
2. serum 25(OH)D3 easy to measure ,accurate , available and affordable
Stop the Vitamin D.
Good hydration.
Re-education about the risk of Vit-D intoxication.
1,25-OH-D3 falls as CKD progresses and can be difficult to accurately measure, as the circulating concentration can be 1000 times lower than the 25-OH-D3 value. The level may appear normal in CKD with secondary hyperparathyroidism.
25(OH)D3 is more accurate and reflects the storage of vitamin D.
This patient has to follow Ca , PTH and 25(oh) d level on the long term
259oh0D3 is the commonly used test to check the Vit D LEVEL IN THE BODY AND EASY TO PERFORM
Suggest a long-term management plan for this patient
Appraise the rationale of serum 25(OH)D3& 1,25(OH) D3 assay in assessment of vitamin D status.
1. Suggest a long-term management plan for this patient.
Follow up vit D levels, calcium and PTH
2.Appraise the rationale of serum 25(OH)D3& 1,25(OH) D3 assay in assessment of vit D status.
Vitamin D is converted into active metabolite 1,25(OH) vit D.
The measurement of 25-OH-D is becoming increasingly important in the management of patients with various disorders of calcium metabolism
Appraise the rationale of serum 25(OH)D3& 1,25(OH) D3 assay in assessment of vit D status.
Serum 25(OH)D is the barometer for vitamin D status.
It is the only vitamin D metabolite that is used to determine whether a patient is vitamin D deficient, sufficient or intoxicated. 25(OH)D is the major circulating form of vitamin D that has a half life of approximately 2-3 weeks
Serum 1,25(OH)2D provides no information about vitamin D status and is often normal or even elevated due to secondary hyperparathyroidism associated with vitamin D deficiency half life of approximately 4-6 hours.
1-long term management plan for this patient :
education and explaination about his condition and avoid any over the counter medication and herbal
2-good hydration
2-vitamin D is rapidly converted to 25(OH)D, but in serum only a fraction of 25(OH)D is converted to its active metabolite 1,25(OH)2D. Thus, measurement of the total 25(OH)D level is the best test to assess body stores of vitamin D
follow up lab investigation
RFT
assessment vit.d
maintain between 20-40 ng/ml > than 30ng /ml
would you please answer the second question?
Suggest a long-term management plan for this patient.
Appraise the rationale of serum 25(OH)D3& 1,25(OH) D3 assay in assessment of vit D status.