@article{21922,
  author = {Lee P. and Nair P. and Venkatesh B. and Myburgh J and Kerr S. and Hoechter D. and Dimeski G. and Grice J. and Center J.},
  title = {A Randomized Study of a Single Dose of Intramuscular Cholecalciferol in Critically Ill Adults},
  abstract = {<p>
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 &lt; 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.
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},
  year = {2015},
  journal = {Critical Care Medicine},
  volume = {43},
  edition = {2015/07/18},
  number = {11},
  pages = {2313-20},
  isbn = {1530-0293 (Electronic), 0090-3493 (Linking)},
  note = {Nair, Priya<br/>Venkatesh, Bala<br/>Lee, Paul<br/>Kerr, Stephen<br/>Hoechter, Dominik J<br/>Dimeski, Goce<br/>Grice, Jeffrey<br/>Myburgh, John<br/>Center, Jacqueline R<br/>United States<br/>Crit Care Med. 2015 Nov;43(11):2313-20. doi: 10.1097/CCM.0000000000001201.},
  language = {eng},
}