Vitamin D deficiency - Revision history

Elcatracho: /* See Also */

2021-02-23T19:20:13Z

Elcatracho: /* See Also */

2021-02-23T19:19:48Z

Elcatracho: /* Clinical Features */

2021-02-23T19:18:58Z

Clinical Features

← Older revision		Revision as of 19:18, 23 February 2021
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	***Soft bones, skeletal deformities		***Soft bones, skeletal deformities
	***Craniotabe: abnormal softening or thinning of the skull		***Craniotabe: abnormal softening or thinning of the skull
	**[[Osteomalacia]] and [[~~Osteoporosis~~]] in adults leading to increased risk of fractures		**[[Osteomalacia]] and [[osteoporosis]] in adults leading to increased risk of fractures
	*Associated with advancement of cancers, particularly of breast, colon, ovarian, and prostate		*Associated with advancement of cancers, particularly of breast, colon, ovarian, and prostate

Elcatracho: /* Background */

2021-02-23T19:18:35Z

Background

ClaireLewis at 17:04, 29 September 2019

2019-09-29T17:04:38Z

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	==Differential Diagnosis==		==Differential Diagnosis==
	*[[Hypocalcemia]]		*[[Hypocalcemia]]
	*Hyperparathyroidism		*[[Hyperparathyroidism]]
	*[[Hypophosphatemia]]		*[[Hypophosphatemia]]
	*Malignancy		*Malignancy
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	==Evaluation==		==Evaluation==
	*Assess for fractures, if indicated		*Assess for [[fractures]], if indicated
	*BMP, Mg/Phos, serum calcium		*BMP, Mg/Phos, serum calcium
	*Vitamin D assessed by measuring serum concentration of 25-hydroxyvitamin D (precursor to hormonally active 1,25-dihydroxyvitamin D)		*Vitamin D assessed by measuring serum concentration of 25-hydroxyvitamin D (precursor to hormonally active 1,25-dihydroxyvitamin D)
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	==Management==		==Management==
	*Treat complications (e.g. fractures, pain)		*Treat complications (e.g. [[fractures]], [[analgesia\|pain]])
	*Supplemental vitamin D		*Supplemental vitamin D
	**Initial high-dosage treatment phase: 1,000 IU cholecalciferol per 10 nmol/L required serum increase given daily for 2-3 months		**Initial high-dosage treatment phase: 1,000 IU cholecalciferol per 10 nmol/L required serum increase given daily for 2-3 months

Mholtz: Text replacement - "-->" to "→"

2017-02-08T19:09:47Z

Text replacement - "-->" to "→"

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	**Fortified foods (mainstay), supplements, fatty fish, egg yolks, fish liver oil, and some mushrooms		**Fortified foods (mainstay), supplements, fatty fish, egg yolks, fish liver oil, and some mushrooms
	**Synthesis of vitamin D occurs in the skin through exposure to ultraviolet B radiation from sunlight		**Synthesis of vitamin D occurs in the skin through exposure to ultraviolet B radiation from sunlight
	*Hydroxylated in ~~liver-->~~ 25-hydroxyvitamin D, which is further hydroxylated in kidney or ~~extrarenally-->~~ 1,25-dihydroxyvitamin D (active form)		*Hydroxylated in liver→ 25-hydroxyvitamin D, which is further hydroxylated in kidney or extrarenally→ 1,25-dihydroxyvitamin D (active form)
	**Second hydroxylation regulated by PTH, serum calcium, and phosphorus levels		**Second hydroxylation regulated by PTH, serum calcium, and phosphorus levels
	*Vitamin D acts to:		*Vitamin D acts to:

Rossdonaldson1: /* References */

2017-01-18T12:00:15Z

References

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	==References==		==References==
	<references/>		<references/>
	*1. <Health Quality Ontario. Clinical utility of vitamin d testing: an evidence-based analysis. ''Ont Health Technol Assess Ser''. 2010;10(2): 1–93.>		#<Health Quality Ontario. Clinical utility of vitamin d testing: an evidence-based analysis. ''Ont Health Technol Assess Ser''. 2010;10(2): 1–93.>
	*2. <Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad H, and Weaver CM. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society Clinical Practice Guideline. "J Clin Endocrinol Metab". Jul 2011; 96(7): 1911–1930.>		#<Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad H, and Weaver CM. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society Clinical Practice Guideline. "J Clin Endocrinol Metab". Jul 2011; 96(7): 1911–1930.>

	[[Category:FEN]]		[[Category:FEN]]

ClaireLewis at 22:42, 15 January 2017

2017-01-15T22:42:13Z

← Older revision		Revision as of 22:42, 15 January 2017
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	*2. <Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad H, and Weaver CM. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society Clinical Practice Guideline. "J Clin Endocrinol Metab". Jul 2011; 96(7): 1911–1930.>		*2. <Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad H, and Weaver CM. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society Clinical Practice Guideline. "J Clin Endocrinol Metab". Jul 2011; 96(7): 1911–1930.>

	~~[[Category:Misc/General]]~~ [[Category:FEN]]		[[Category:FEN]]

ClaireLewis: /* Differential Diagnosis */

2017-01-15T22:36:24Z

Differential Diagnosis

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	*[[Hypophosphatemia]]		*[[Hypophosphatemia]]
	*Malignancy		*Malignancy
			*[[Nonaccidental trauma]]

	==Evaluation==		==Evaluation==

ClaireLewis at 22:26, 15 January 2017

2017-01-15T22:26:33Z

← Older revision		Revision as of 22:26, 15 January 2017
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	==Background==		==Background==
	*AKA: Hypovitaminosis D		*AKA: Hypovitaminosis D
	*Vitamin D		*Vitamin D deficiency leads to impaired bone mineralization and diseases such as:
	**Lipid soluble
	**Acts as a hormone which:
	***Stimulates intestinal calcium absorption
	***Maintains adequate phosphate levels for bone development
	***Regulates cell growth proliferation and apoptosis
	***Modulates immune function and inflammation reduction
	*Deficiency leads to impaired bone mineralization and ~~disease~~ such as:
	**[[Rickets]] in children		**[[Rickets]] in children
	**[[Osteomalacia]] and [[Osteoporosis]] in adults		**[[Osteomalacia]] and [[Osteoporosis]] in adults
			===Metabolism and Physiology of Vitamin D===
	==Metabolism and Physiology of Vitamin D==		*Gained from diet, supplements, or sunlight exposure
	*~~Vitamin D gained~~ from diet, supplements, or sunlight exposure		**Fortified foods (mainstay), supplements, fatty fish, egg yolks, fish liver oil, and some mushrooms
	*~~Vitamin D undergoes hydroxylation in the liver producing 25-hydroxyvitamin D~~
	*~~A second hydroxylation occurs in the kidney producing 1~~,~~25-dihydroxyvitamin D which is the active form of vitamin D~~
	**This step can occur extrarenally
	**Regulated by PTH, serum calcium, ~~and phosphorus levels~~

	~~==Etiology of Vitamin D Deficiency==~~
	*Inadequate intake
	**Dietary sources such as fortified foods and supplements are the mainstay of vitamin D intake
	**Foods rich in vitamin D include fatty fish, egg yolks, fish liver oil, and some mushrooms
	*Inadequate sunlight exposure
	**Synthesis of vitamin D occurs in the skin through exposure to ultraviolet B radiation from sunlight		**Synthesis of vitamin D occurs in the skin through exposure to ultraviolet B radiation from sunlight
	**~~Factors associated with vitamin D deficiency include darker skin pigmentation~~, ~~prolonged winter season~~, and ~~skin coverage~~		*Hydroxylated in liver--> 25-hydroxyvitamin D, which is further hydroxylated in kidney or extrarenally--> 1,25-dihydroxyvitamin D (active form)
	*~~Disorders limiting~~ vitamin D absorption		**Second hydroxylation regulated by PTH, serum calcium, and phosphorus levels
	**[[Crohn's disease]]		*Vitamin D acts to:
	**[[~~Cystic~~ fibrosis]]		**Stimulate intestinal calcium absorption
	*~~Conditions preventing~~ vitamin D ~~conversion~~ into active metabolites		**Maintain adequate phosphate levels for bone development
	**[[Renal Failure]]		**Regulate cell growth proliferation and apoptosis
	**[[Liver failure]]		**Modulate immune function and inflammation reduction
			===Etiology of Vitamin D Deficiency===
			*Inadequate dietary intake, inadequate sunlight exposure
			*Impaired vitamin D absorption
			**[[Crohn's disease]], [[cystic fibrosis]]
			*Impairment in conversion of vitamin D into active metabolites
			**[[Renal Failure]], [[Liver failure]]

	==Clinical Features==		==Clinical Features==
	*Bone pain ~~and muscle~~ weakness		*Bone pain
			*Muscle [[weakness]]
	*Brittle bones		*Brittle bones
	**[[Rickets]] in children		**[[Rickets]] in children
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	***Craniotabe: abnormal softening or thinning of the skull		***Craniotabe: abnormal softening or thinning of the skull
	**[[Osteomalacia]] and [[Osteoporosis]] in adults leading to increased risk of fractures		**[[Osteomalacia]] and [[Osteoporosis]] in adults leading to increased risk of fractures
	*Associated with advancement of cancers		*Associated with advancement of cancers, particularly of breast, colon, ovarian, and prostate
	**Breast, colon, ovarian, and prostate

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Evaluation==		==Evaluation==
	*~~Diagnosed~~ by measuring ~~the~~ concentration of 25-hydroxyvitamin D		*Assess for fractures, if indicated
	**This is the pre hormone, calcidiol, which is a precursor to ~~the~~ active ~~form~~ 1,25-dihydroxyvitamin D		*BMP, Mg/Phos, serum calcium
	*~~Insufficient vitamin D defined as a 25-hydroxyvitamin level 25-75 nmol/L (normal~~ range 75-250 nmol/L)		*Vitamin D assessed by measuring serum concentration of 25-hydroxyvitamin D (precursor to hormonally active 1,25-dihydroxyvitamin D)
	*~~Vitamin D deficiency defined as a~~ 25-~~hydroxyvitamin level~~ <~~20-~~25 nmol/L		**Normal range: 75-250 nmol/L
	*Screening adults not at risk and without symptoms not recommended		**Insufficiency: 25-75 nmol/L
			**Deficiency: <25 nmol/L
			**Screening adults not at risk and without symptoms not recommended

	==Management==		==Management==
			*Treat complications (e.g. fractures, pain)
	*Supplemental vitamin D		*Supplemental vitamin D
	**Initial high-dosage treatment phase		**Initial high-dosage treatment phase: 1,000 IU cholecalciferol per 10 nmol/L required serum increase given daily for 2-3 months
	~~***~~1,000 IU cholecalciferol per 10 nmol/L required serum increase given daily for 2-3 months		**Maintenance: 400 IU daily
	**~~Followed by maintenance dosage~~		***Double dosage for premature infants, infants/children with dark pigmentation, children with limited sun exposure, and obese patients
	~~***~~400 IU daily ~~for all age groups~~		**Some populations may require higher dosing (i.e. parathyroid disease, chronic liver disease, renal failure, and malabsorption disorders)
	***Double dosage for premature infants, ~~dark pigmented~~ infants/children, children with limited sun exposure, and obese patients
	**~~Special~~ populations may require higher dosing (i.e. parathyroid disease, chronic liver disease, renal failure, and malabsorption disorders

	==See Also==		==See Also==
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	*2. <Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad H, and Weaver CM. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society Clinical Practice Guideline. "J Clin Endocrinol Metab". Jul 2011; 96(7): 1911–1930.>		*2. <Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad H, and Weaver CM. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society Clinical Practice Guideline. "J Clin Endocrinol Metab". Jul 2011; 96(7): 1911–1930.>

	[[Category:Misc/General]]		[[Category:Misc/General]] [[Category:FEN]]

← Older revision		Revision as of 19:20, 23 February 2021
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	*[[Hypophosphatemia]]		*[[Hypophosphatemia]]

	{{template:~~Vitamin~~ deficiencies}}		{{template:vitamin deficiencies DDX}}

	==External Links==		==External Links==

← Older revision		Revision as of 19:19, 23 February 2021
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	*[[Hypocalcemia]]		*[[Hypocalcemia]]
	*[[Hypophosphatemia]]		*[[Hypophosphatemia]]

			{{template:Vitamin deficiencies}}

	==External Links==		==External Links==

← Older revision		Revision as of 19:18, 23 February 2021
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	*Vitamin D deficiency leads to impaired bone mineralization and diseases such as:		*Vitamin D deficiency leads to impaired bone mineralization and diseases such as:
	**[[Rickets]] in children		**[[Rickets]] in children
	**[[Osteomalacia]] and [[~~Osteoporosis~~]] in adults		**[[Osteomalacia]] and [[osteoporosis]] in adults

	===Metabolism and Physiology of Vitamin D===		===Metabolism and Physiology of Vitamin D===
	*Gained from diet, supplements, or sunlight exposure		*Gained from diet, supplements, or sunlight exposure
	**Fortified foods (mainstay), supplements, fatty fish, egg yolks, fish liver oil, and some mushrooms		**Fortified foods (mainstay, eg milk, cereals), supplements, fatty fish, egg yolks, fish liver oil, and some mushrooms
	**Synthesis of vitamin D occurs in the skin through exposure to ultraviolet B radiation from sunlight		**Synthesis of vitamin D occurs in the skin through exposure to ultraviolet B radiation from sunlight
	*Hydroxylated in liver→ 25-hydroxyvitamin D, which is further hydroxylated in kidney or extrarenally→ 1,25-dihydroxyvitamin D (active form)		*Hydroxylated in liver→ 25-hydroxyvitamin D, which is further hydroxylated in kidney or extrarenally→ 1,25-dihydroxyvitamin D (active form)
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	**Regulate cell growth proliferation and apoptosis		**Regulate cell growth proliferation and apoptosis
	**Modulate immune function and inflammation reduction		**Modulate immune function and inflammation reduction

	===Etiology of Vitamin D Deficiency===		===Etiology of Vitamin D Deficiency===
	*Inadequate dietary intake, inadequate sunlight exposure		*Inadequate dietary intake, inadequate sunlight exposure
			**Especially individuals with higher melanin content living in colder climates
	*Impaired vitamin D absorption		*Impaired vitamin D absorption
	**[[Crohn's disease]], [[cystic fibrosis]]		**[[Crohn's disease]], [[cystic fibrosis]], pancreatic insufficiency
	*Impairment in conversion of vitamin D into active metabolites		*Impairment in conversion of vitamin D into active metabolites
	**[[Renal Failure]], [[Liver failure]]		**[[Renal Failure]], [[Liver failure]]