Acute fluid shifts influence the assessment of serum vitamin D status in critically ill patients

Krishnan, Anand, Ochola, Judith, Mundy, Julie, Jones, Mark, Kruger, Peter, Duncan, Emma, & Venkatesh, Bala (2010) Acute fluid shifts influence the assessment of serum vitamin D status in critically ill patients. Critical Care, 14(6), R216.

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Abstract

Introduction

Recent reports have highlighted the prevalence of vitamin D deficiency and suggested an association with excess mortality in critically ill patients. Serum vitamin D concentrations in these studies were measured following resuscitation. It is unclear whether aggressive fluid resuscitation independently influences serum vitamin D.

Methods

Nineteen patients undergoing cardiopulmonary bypass were studied. Serum 25(OH)D3, 1α,25(OH)2D3, parathyroid hormone, C-reactive protein (CRP), and ionised calcium were measured at five defined timepoints: T1 - baseline, T2 - 5 minutes after onset of cardiopulmonary bypass (CPB) (time of maximal fluid effect), T3 - on return to the intensive care unit, T4 - 24 hrs after surgery and T5 - 5 days after surgery. Linear mixed models were used to compare measures at T2-T5 with baseline measures.

Results

Acute fluid loading resulted in a 35% reduction in 25(OH)D3 (59 ± 16 to 38 ± 14 nmol/L, P < 0.0001) and a 45% reduction in 1α,25(OH)2D3 (99 ± 40 to 54 ± 22 pmol/L P < 0.0001) and i(Ca) (P < 0.01), with elevation in parathyroid hormone (P < 0.0001). Serum 25(OH)D3 returned to baseline only at T5 while 1α,25(OH)2D3 demonstrated an overshoot above baseline at T5 (P < 0.0001). There was a delayed rise in CRP at T4 and T5; this was not associated with a reduction in vitamin D levels at these time points.

Conclusions

Hemodilution significantly lowers serum 25(OH)D3 and 1α,25(OH)2D3, which may take up to 24 hours to resolve. Moreover, delayed overshoot of 1α,25(OH)2D3 needs consideration. We urge caution in interpreting serum vitamin D in critically ill patients in the context of major resuscitation, and would advocate repeating the measurement once the effects of the resuscitation have abated.

Impact and interest:

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ID Code: 94180
Item Type: Journal Article
Refereed: Yes
Additional URLs:
Keywords: C reactive protein, calcitriol, calcium ion, parathyroid hormone, vitamin D, biological marker, adult, article, calcium blood level, cardiopulmonary bypass, clinical article, critically ill patient, female, fluid shift, human, intensive care unit, male, parathyroid hormone blood level, patient assessment, priority journal, protein blood level, vitamin blood level, acute disease, aged, blood, comparative study, critical illness, hemodilution, middle aged, physiology, time, vitamin D deficiency, Biological Markers, Fluid Shifts, Humans, Time Factors
DOI: 10.1186/cc9341
ISSN: 1364-8535
Divisions: Current > Schools > School of Biomedical Sciences
Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Copyright Owner: Copyright 2010 Krishnan et al.; licensee BioMed Central Ltd.
Copyright Statement: This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (<url>http://creativecommons.org/licenses/by/2.0</url>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Deposited On: 28 Mar 2016 23:36
Last Modified: 30 Mar 2016 00:38

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