VITAMIN D
 
  • Dosing
    		•
  • Therapeutic Uses
    		•
  • Sources
    		•
  • High-Risk Groups
    		•
  • Deficiency Consequences
    		•
  • Toxicity/Side Effects
    		•
  • Contraindications
    		•
  • Additional Information
    		•
  • Drug Interactions
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    United States Recommended Dietary Allowances
    Men - 400 IU, Women - 200 - 400 IU, Pregnant women - 800 IU
    Nursing mothers - 1200 - 1300 IU, Children - 400 IU, Infants - 300 IU
    400 IU of Vitamin D = 10 micrograms of cholecalciferol







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    Therapeutic Uses
    Vitamin D in conjunction with parathormone (PTH) in responsible for calcium homeostasis (calcium deposition - mineralization - and removal - demineralization - from bone). Reverses symptoms of nutritional rickets or osteomalacia unless permanent deformities have occurred.





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    Sources
    Fortified milk, cod liver oil, canned fish.






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    High-Risk/Increased Need Groups
    Strict vegetarians, confined persons, women with closely spaced multiple pregnancies, severe fat malabsorption syndromes, long term dilantin use. Elderly especially diabetics, kidney disease or osteoporosis. Vitamin D synthesis decreases with age.






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    Deficiency Consequences
    Progressive hearing loss, rickets in children and osteomalacia in adults.






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    Toxicity/Side Effects
    Early - weakness, headache, somnolence, nausea, vomiting, dry mouth, constipation, muscle pain, bone pain, metallic taste.
    Late - Polyuria, polydipsia anorexia, irritability, weight loss, nocturia, conjunctivitis (calcific), pancreatitis, photophobic, rhinorrhea, pruritus, hyperthermia, decreased libido, elevated BUN, albuminuria, hypercholesterolemia, elevated SGOT & SGPT, ectopic calcification, hypertension, cardiac arrhythmias and rarely overt psychosis.







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    Contraindications
    Hypercalcemia, evidence of Vitamin D toxicity, malabsorption syndrome, hypervitaminosis D, abnormal sensitivity to the effects of Vitamin D.







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    Additional Information/Precautions
    Vitamin D is a fat soluble vitamin. It is stored mostly in the liver and adipose tissue. Natural supplies of Vitamin D depend on ultraviolet light for conversion to the active form of Vitamin D. Best results when taking Vitamin D are obtained with calcium supplementation. Notify your physician if you notice any toxic effects (hypercalcemia as noted above). Avoid use of mineral oil. If on renal dialysis, avoid magnesium containing antacids while taking Vitamin D. Vitamin D refers to ergocalciferol (D2 synthetic) and cholecalciferol (D3 natural). Minimum sun exposure of 30 minutes per day on face and hands are necessary for adequate synthesis in normal persons. Use of sunscreens significantly reduces Vitamin D synthesis in skin and SPF factor of 8 completely blocks Vitamin D synthesis.






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    Drug Interactions
    Magnesium containing antacids may lead to development of hypermagnesemia. Cholestyramine (Questran) has been reported to decrease intestinal absorption of all fat soluble vitamins. Prolonged use of mineral oil interferes with the absorption of all fat soluble vitamins. If taking digitalis, watch out for hypercalcemia as it may precipitate cardiac arrhythmias. Thiazide diuretics (Diuril, Hydrodiuril, Enduron, Lozol are some examples) may cause hypercalcemia in hypothyroid patients taking Vitamin D. Phenytoin (Dilantin) and barbiturates may increase the breakdown of Vitamin D. Verapamil (Calan, Isoptin, Covera-HS, Verelan) treated patients have experienced recurrence of atrial fibrillation.





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    References
    1. Chiropractic Nutritional Reference 1987 Edition, James M. Gerber, DC
    2. Facts and Comparisons Drug Information, Updated Monthly, Loose-leaf drug information service
    3. Understanding Vitamins and Minerals, by the editors of Prevention Magazine, 1984