The patient had been started on vitamin D3 (6000 IU/d) and was referred for detailed psychiatric assessment. Four weeks later, the patient reported feeling well with better energy. She was instructed to continue on the regimen as previously described. Â
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Appraise the above management plan in view of the current recommendations
The vitamin D dose required to treat vit D deficiency depends on:
In patients with normal absorptive capacity, for every 100 units of added vit D, serum 25(OH)D concentrations increase by approximately 0.7 to 1.0 ng/mL.
so for this patient I will give her
Loading dos: 50,000 iu weekly or 6000 iu daily for 6-8 weeks.
Maintenance dose: 800 iu daily.
Discuss the pleiotropic effects of vit D
50000iu weekly for 3 months after normalize 1000 daily
anti-inflammatory effect
-improve immune system
-anti-proteinuric
-effect BP LV function
anti-atherogenic effect
anti-depressive effect
anti-neoplastic effect
-improve anemia in CKD patients
1- 50000 iu for 6 wks then 1000 iu daily
2- a lot like BP , DM , immunity , malignancy , mentally
loading regime 5000 units for 8 weeks then vitamin D 800 unit daily
it can act on immunity, as anti cancer agent and anti inflammatory too
sun exposure and dietary supplement , patient needs vitamin d supplement 50000 iu weekly and when vitamin D reaches 30ng switch to vitamin dof 1000 to 2000
2- increased calcium and phosphorus absorption from GIT
inhibition of PTH secretion
increased bone mineralization
increased expression of FGF 23
Beside good dietary supplementations and sun exposure, patients with serum 25(OH)D <12 ng/mL (30 nmol/L), initial supplementation for 8 weeks with Vitamin D3 either 6,000 IU daily or 50,000 IU weekly can be considered. Once the serum 25-hydroxyvitamin D level exceeds 30 ng/mL, a daily maintenance dose of 1,000 to 2,000 IU is recommended.
In addition to the maintenance of calcium and phosphorus balance, vitamin D regulates the function of the kidneys, heart, and immune system. Moreover, its anti-inflammatory, antiapoptotic, and antifibrotic roles have gained considerable attention. Vitamin D is also important for the maintenance of homeostasis by regulation of hormone secretion, cell proliferation, and differentiation.
1. Appraise the above management plan in view of the current recommendations.
Beside good dietary supplementations and sun exposure, patients with serum 25(OH)D <12 ng/mL (30 nmol/L), initial supplementation for 8 weeks with Vitamin D3 either 6,000 IU daily or 50,000 IU weekly can be considered. Once the serum 25-hydroxyvitamin D level exceeds 30 ng/mL, a daily maintenance dose of 1,000 to 2,000 IU is recommended.
2.Discuss the pleiotropic effects of vit D.
APC: antigen presenting cells
DC: dendritic cells
Igs: immunoglobulins
50,000 IU weekly for 7 weeks
Pleiotropic effects of vitD: Improve cardiovascular function..Augument immune system. Neuronal support.Improve cognitive dysfunction. Renal protection, (antiproteinuric and anti-fibrotic).Anti-inflammatory properties.
1.Appraise the above management plan in view of the current recommendations.
As a therapeutic dose , this dose is quite enough with close monitoring of vitamin D level, ca, and p.
2.Discuss the pleiotropic effects of vit D.
–anti-inflammatory effect
-improve immune system
-anti-proteinuric
-improve BP
-improve LV function
-improve endothelial function
-has anti-atherogenic effect
-has anti-depressive effect
-has anti-neoplastic effect
-improve anemia in CKD patients.
1- these dose is high according to guide line give 50000iu / wk for 12 wk then monthly for 3 months recheck the level of vit D and take maintenance dose 800mg / day with monitoring of ca po4.
2 pleiotropic effect of vit D
maintenance of calcium and phosphorus balance.
Also vitamin D regulates the function of the kidneys, heart, and immune system.
Moreover, its anti-inflammatory, antiapoptotic, and antifibrotic roles.
Management plan
Pleiotroffic effects
1.Appraise the above management plan in view of the current recommendations.
The dose given is high. the recommended dose is 800-2000 per day
or ergocalciferol 50000 iu/week for 12 weeks then monthly for 3 months.
need close observation of calcium and phophorus
2.Discuss the pleiotropic effects of vit D.
In addition to maintaining calcium and phosphorus balance, vitamin D regulates the function of the kidneys, heart, and immune system. Moreover, its anti-inflammatory, antiapoptotic, and antifibrotic roles have gained considerable attention. Vitamin D is also important for the maintenance of homeostasis by regulating hormone secretion, cell proliferation, and differentiation.
YES NEEDS FOR VIT D SUPPLEMENTAION 50000 / WEEK FOR A PERIOD THEN RECHECK THE LEVEL , VIT D HAS MANY POSITIVE EFFECT ON THE KIDNEY , HEART , COGNITIVE FUNCTION AND OTHER EFFECTS
maintenance of calcium and phosphorus balance.
vitamin D regulates the function of the kidneys, heart, and immune system.
Moreover, its anti-inflammatory, antiapoptotic, and antifibrotic roles
The above recommendation
50,000 IU weekly for 7 weeks, guided by clinical improvement and laboratory tests, provided that the patient is taking drugs lowering vitD level.
Pleiotropic effects of vitD
1.the patient can take this treatment daily for 12 weeks or 50000 iu weekly for 12 weeks or 500000iu as a single I’m injection
2. The vitamin very important for bone health and teeth., renal effect as antiproteiuric, increase nephrin expression, inhibit TNCE, effect on CVS decrease calcification in vessels, improve the immune system, it inhibit th1 and increase th2 and inhibit icam, vcam, IL 8 , also has anticancer effect
As this patient is defecent in vitamin d, replacement can be done I’m many protocols. 50.000 IU/week for 12 weeks followed by 50.000/month . or 500.000 im/month.
vitamin D has many pleiotropic effects affecting the immune system, cardiovascular system, and endothelium. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4045445/table/tab1/)
Vit D3 of 6000 daily is high dose possible to take 2-000 daily or ergocalciferol of 50000on weekly bases .
Need regular monitoring for the 25 (OH) level and Ca nad Poe
need to check his PTH level .
Vit D has anti apoptotic ,anti proliferative and anti fibrotic effects .
it regulates function of heart ,kidneys and immune system .
The dose given is high. the recommended dose is 800-2000 per day
or ergocalciferol 50000 iu/week for 12 weeks then monthly for 3 months.
need close observation of calcium and phophorus
In addition to maintaining calcium and phosphorus balance, vitamin D regulates the function of the kidneys, heart, and immune system. Moreover, its anti-inflammatory, antiapoptotic, and antifibrotic roles have gained considerable attention. Vitamin D is also important for the maintenance of homeostasis by regulating hormone secretion, cell proliferation, and differentiation.
1.Appraise the above management plan in view of the current recommendations.
2.Discuss the pleiotropic effects of vit D
Data from observational studies showed:
1. Appraise the above management plan in view of the current recommendations.
vitamin D3 (6000 IU/d) as a start followed by maintenance 600 iu /day
2. Discuss the pleiotropic effects of vit D.
Vitamin D has a role in maintaining calcium and phosphorus balance
Vitamin D regulates the function of the kidneys, heart, and immune system
Vitamin D have anti-inflammatory, antiapoptotic, and antifibrotic roles have gained considerable attention
Vitamin D also maintains homeostasis by regulating of hormone secretion, cell proliferation, and differentiation.
Appraise the above management plan in view of the current recommendations.
Recommendation to start 200.000 iu then follow up vit-D level .
maintenance dose (600iu) daily.
Discuss the pleiotropic effects of vit D.
1-duration of loading VIT D (D3 300000 iu) then maintenance 600 iu /day
2-neurological assesessment as regard anticonvulsant
2-plieotropic effects of vit d :
, its anti-inflammatory, antiapoptotic, and antifibrotic roles h
the above management is the best
In addition of the role of vit.D in regulation and maintenance of ca and pi though its effect on bone and parathyroid gland and GIT
the recent action of vit. as pleiotropic hormone
1-anti inflammatory >>>effect on immune system (T- B-cell , macrophage and monocyte )
2-anti cancer >>>>important in regulation of cell growth
3-anti atherogenic
4-help in control blood sugar >>>increase sensitivity of insulin
5-improve left ventricular hyper trophy
6- has anti-proteinuric effect
Appraise the above management plan in view of the current recommendations.
Discuss the pleiotropic effects of vit D.