**2. Extraskeletal dysfunction in vitamin D deficiency**

A brief menu of organ dysfunction previously reported is now presented as a prelude to understanding possible contribution to prolonged recovery or higher mortality in seriously ill ICU patients [1].


**97**

*Extraskeletal Effects of Vitamin D Deficiency in Intensive Care Patients*

comorbidity in intensive care unit patients.

correction, or supplementation of vitamin D to prevent or control hypertension. In the Framingham Study [4], a relationship of vitamin D deficiency and risk of cardiovascular events was raised. This concern was furthered by data from the National Health and Nutrition Education Survey (NHANES) data [5].

h.Diabetes: as alluded previously there have been studies of increased incidence and severity of type 1 diabetes mellitus (T1DM) in vitamin D populations, but the evidence has not been conclusive. Diabetes is likely the most common

i. Neuropsychiatry: despite the relationship of calcium and vitamin D to membrane transport and neurohumoral secretion, the impact of vitamin D or its supplementation or augmentation on ICU neurologic diseases such as stroke or

j. Pregnancy: there are reports of more complications with vitamin D-deficient mothers. No definitive studies suggest a role for monitoring or replacement or augmentation in ICU syndromes in pregnancy such as preeclampsia or hemoly-

There are multiple publications concerning vitamin D deficiency affecting mortality in seriously ill patients [6, 7]. Whereas these studies are prospective and controlled, the numbers of patients have not been great. In a report by Han et al. [7] high-dose vitamin D administration was studied in ventilated intensive care unit patients. This was a small pilot double-blinded randomized controlled trial. Twelve subjects were in each group. The levels were low in 43% of patients. The groups were given 50,000 vs. 1,000,000 units daily enterally vs. placebo for 5 days. High-dose vitamin D3 increased levels of 25OHD and led to decreased numbers of hospital days without any other improved clinical outcomes. The decrease in hospital length of stay not ICU days or ventilator days or hospital-acquired infec-

There are additional reports of the role of vitamin D in patients with specific major organ dysfunction. These reports have studied heart, lung, or kidney failure in the ICU. Those studies which have dealt with vitamin D supplements to assist with patients to be liberated from the ventilator because of respiratory failure have shown no benefit

There are a considerable number of journal articles dealing with cardiac function in patients with disturbed calcium metabolism [8] and improvement of heart failure with vitamin D administration [9]. Renal failure is another common organ failure developing in seriously ill patient who requires often intensive care. There is a long tradition of vitamin D administration to dialysis patients due to their impaired renal activation of 25OH vitamin D to 1,25 dihydroxyvitamin D. New findings from a real-world study of 52,757 patients confirmed that vitamin D

In the past few decades, there appeared to be a crescendo of possible multisystem benefits from vitamin D supplementation reported throughout the world

of supplementation to reduce time on the ventilator and speed liberation [7].

sis, elevated liver enzymes, and low platelets (HELLP) syndrome.

**3. Studies of vitamin D specific to patients in the ICU**

tions, hospital mortality, or mortality at day 84 was seen.

improves survival in hemodialysis patients [10].

**4. Contradictory recent major studies**

*DOI: http://dx.doi.org/10.5772/intechopen.89317*

seizures has not been proven.

*Fads and Facts about Vitamin D*

all-cause mortality were furthering this expanded role for vitamin D [5]. The purpose of this chapter is to review the evidence for and against the impact of deficiency of vitamin D on the most seriously ill patients, those in the intensive care unit (ICU).

A brief menu of organ dysfunction previously reported is now presented as a prelude to understanding possible contribution to prolonged recovery or higher

a.Muscle weakness: some descriptive studies have associated muscle weakness with vitamin D deficiency. For example, vitamin D-deficient children have severe muscle weakness. However, randomized studies of supplementation

b.Falls due to musculoskeletal dysfunction has been reported to be associated with increased vitamin D-deficient elders with benefit of supplementation seen in many studies, especially in those patients with the lowest 25-hydroxy

c.Cancer incidence is associated with vitamin D deficiency for patients with colon cancer and breast cancer in postmenopausal women, but not prostate cancer. There are many small series of worsening outcomes in hematologic malignancies, especially in children, in vitamin D-deficient individuals, but supplementation has not been clearly shown to improve outcomes. Since many of these patients are admitted to the ICU for short-term management of emergency complications of their diseases or treatments, surveillance of vitamin D may be important to the management of these patients. A very recent report on the subject of vitamin D supplementation and colorectal cancer will be

d.Immune system: vitamin D has effects on all cells of the immune system, and there are reports of deficiency associated with such immune-mediated diseases as diabetes, multiple sclerosis, and inflammatory bowel disease. Certainly in patients with these medical problems, complications develop requiring admission to the ICU. So it would seem that more studies and larger numbers of patients in these series are needed in the monitoring and at least maintenance of normal levels in patients with these common immune-mediated diseases.

e.Asthma: severe bronchospasm is a common reason for admission to the ICU, often in a younger or pediatric patient. The data on the role of vitamin D in this problem thus far is considered inconclusive. There has also been no good evidence of the need to aggressively search or supplement vitamin D in patients

f. Infection: despite the evidence for vitamin D on the immune system, no

g.CV system: in my introduction to this book, I review my previous work on the role of calcium and vitamin D in vascular tone and blood pressure [2, 3]. Despite these reports, no conclusive evidence has led to routine screening,

D to improve success in the management of seriously ill patients.

specific infections have required correction or supplementation with Vitamin

**2. Extraskeletal dysfunction in vitamin D deficiency**

have only led to some improvement in these series.

presented in the Conclusion section of this chapter.

with chronic obstructive pulmonary disease (COPD).

mortality in seriously ill ICU patients [1].

vitamin D levels, < 25 nmol/L.

**96**

correction, or supplementation of vitamin D to prevent or control hypertension. In the Framingham Study [4], a relationship of vitamin D deficiency and risk of cardiovascular events was raised. This concern was furthered by data from the National Health and Nutrition Education Survey (NHANES) data [5].

