There are several steps that health care providers can take to assure this approach is possible: (1) arrange for rapid processing of 25-hydroxyvitamin D [25(OH)D] and serum calcium specimens; (2) gain approval from the hospital pharmacy and therapeutics committee to stock 5,000 IU vitamin D capsules; (3) identify key staff physicians to provide consultative expertise in the rapid repletion of vitamin D in septic patients; (4) identify key pharmacists who can support provider and nursing education as well as patient specific therapeutic efforts; (5) identify key nurses to educate staff in the ER, ICU and ward settings; (6) consider notifying providers of vitamin D status, if known, at the time antibiotics or anti-viral agents are ordered; (7) correlate mortality data with vitamin D status in hospital-wide, blinded, non-judgmental communications; (8) correlate cost and length of stay data with vitamin D status in patients with infections; (9) consider addressing vitamin D status in patients at the time of scheduling for elective surgeries.
Capsules of 50,000 IU vitamin D3 are available (e.g., Biotech Pharmacal) and can be given to patients with very low serum 25-hydroxyvitamin D concentrations.
Self-education is available at vitamindcouncil.com. Vitamin D conferences have been available at several sites in North America and Europe.
Having practiced as a family physician for 25 y using the standard vitamin D dose of 400 IU and five years using vitamin D dosing sufficient to give blood levels > 50 ng/ml (> 120 nmoles/ml), I will never return to the “inky dinky dose” again.
Bailey BA, Manning T, Peiris AN.
Vitamin D testing patterns among six Veterans Medical Centers in the southeastern United States: links with medical costs
Mil Med 2012;
177:70-6; PMID: 22338984