Research Article
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Vitamin D Levels of Pediatric Intensive Care Patients

Year 2018, Volume: 10 Issue: 3, 326 - 332, 23.10.2018
https://doi.org/10.18521/ktd.319492

Abstract

Objective: By measuring serum 25-hydroxyvitamin D (25-OHVitD) levels of the patients in Pediatric Intensive Care Unit (PICU), vitamin D supplementation is aimed to those who have been determined to have vitamin D deficiency. Furthermore, it is aimed to compare the vitamin D levels of only acute disease patients with acute disease added to the chronic disease in PICU.

Methods: 327 patients (Group A) aged in the range of 1 month to 18 years, that have been hospitalized in PICU of İnönü University TurgutÖzal Medicine Centre from January 2015 to June 2016, and 90 healthy subjects as a control group (Group B) were included. Group A was divided into two; patients with only acute disease (A1=125 patients) and patients with acute disease added to the chronic disease (A2=202 patients). Demographic information and 25-OHVitD, Ca, P, ALP levels of all cases were recorded retrospectively.

Results: Mean of the 25-OHVitD level was 20.9±16.4 ng/dl in Group A; 25.7±17.2 ng/dl in Group A1;17.9±15.2 ng/dl in Group A2 and 25.9±14.4 ng/dl in Group B, respectively. Vitamin D deficiency was 55% in Group A, 43.2% in Group A1, 62.4% in Group A2 and 40% in Group B. In addition, vitamin D insufficiency was 16% in Group A, 17.6% in Group A1, 14.9% in Group A2 and 20% in Group B. On the other hand, vitamin D sufficiency was 29% in Group A, 39.2% in Group A1, 22.8% in Group A2, and 40% in Group B. The increase of age and presence of chronic illness were the determining factors of vitamin D level.

Conclusion: It has been found that, the incidence of vitamin D deficiency increases in prevalence, as age increases. The patients in PICU, especially those who have chronic illness, were found to have vitamin D deficiency more frequent. It is concluded that elimination of vitamin D deficiency may contribute to the treatment of the disease for the patients in PICU and the children with chronic illness.

References

  • 1. Yurdakök M. Doğa ve insan tarihinde vitamin D. Katkı Pediatri Dergisi 1990; 11:345–386. 2. Yurdakök M. Pediatrik Paleopatoloji Kemikler Mumyalar ve Çocuklar. Ankara: Öztürk Matbaası, 1986:1-86. 3. Lee DM, Rutter MK, O'Ne ill TW, et al. European Male Ageing Study Group. Vitamin D, parathyroid hormone and the metabolic syndrome in middle-aged and older European men. Eur J Endocrinol 2009;161(6):947-954. 4. Humble MB. Vitamin D, light and mental health. J Photochem Photobiol B 2010;101(2):142-149. 5. Nimitphong H, Holick MF. Vitamin D, neurocognitive functioning and immunocompetence. Curr Opin Clin Nutr Metab Care 2011;14(1):7-14. 6. Cranney A, Horsley T, O'Donnell S, et al. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess (Full Rep) 2007;(158):1-235. 7. Dobnig H, Pilz S, Scharnagl H, et al. Independent association of low serum 25-hydroxy vitamin d and1,25-dihydroxy vitamin d levels with all-cause and cardiovascular mortality. Arch In tern Med 2008;168(12):1340-1349. 8. Rippel C, South M, Butt WW, et al. Vitamin D status in critically ill children. Intensive Care Med 2012 Dec; 38(12): 2055-2062. 9. Misra M, Pacaud D, Petryk A, et al; Drug and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society: Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics 2008;122, 398-417,. 10. Gordon CM, DePeter KC, Feldman HA, et al. Prevalence of vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med. 2004;158, 531-537. 11. Rippel C, South M, Butt WW, et al. Vitamin D status in critically ill children. Intensive Care Med (2012); 38:2055–2062. 12. Singhi SC, Singh J, Prasad R. Hypocalcaemia in a paediatric intensive care unit. J Trop Pediatr 2003;49: 298-302. 13. Lee P, Eisman JA, Center JR: Vitamin D deficiency in critically ill patients. N Engl J Med, 2009a: 360, 1912-1914. 14. Desai TK, Carlson RW, Geheb MA: Parathyroid-vitamin D axis in critically ill patients with unexplained hypocalcemia. Kidney Int Suppl 1987;22: 225-228. 15. Maiya S, Allgrove J, Mok Q. Vitamin D deficiency and mortality and serious morbidity in infancy: time for action. Arch Dis Child 2006;91, A71. 16. Kumar J, Muntner P, Kaskel FJ, Hailpern SM, Melamed ML: Prevalence and associations of 25-hydroxyvitamin D deficiency in U.S. children: NHANES 2001-2004. Pediatrics 2009;124, e362-e370. 17. McNally JD, Menon K, Chakraborty P, et al. Canadian Critical Care Trials Group: The association of vitamin D status with pediatric critical illness. Pediatrics 2012;130:429-436. 18. Madden K, Feldman HA, Smith EM, et al. Vitamin D deficiency in critically ill children. Pediatrics 2012;130:421-428. 19. Lee P. Vitamin D metabolism and deficiency in critical illness. Best Pract Res Clin Endocrinol Metab 2011 Oct; 25(5): 769-781. 20. Rey C, Sánchez-Arango D, López-Herce J, et al. Vitamin D deficiency at pediatric intensive care admission. J Pediatr (Rio J) 2014 Mar-Apr; 90(2): 135-142. 21. Çiğdem H. Kritik hasta çocuklarda d vitamini eksikliğinin sikliği ve prognozla ilişkisi uzmanlık tezi. Samsun Ondokuz Mayıs üniversitesi 01.2016. 22. Güneş N. Yoğun bakim hastalarinda D vitamini düzeyi takibi uzmanlık tezi. İÜ Cerrahpaşa tıp fakültesi. 2014 23. Holick MF. Vitamin D deficiency. N Engl J Med 2007;357, 266-281. 24. Ayulo M Jr, Katyal C, Agarwal C et al. The prevalence of vitamin D deficiency and its relationship with disease severity in an urban pediatric critical care unit. Endocr Regul. 2014;48:69–76. 25. Hebbar KB, Wittkamp M, Alvarez JA et al. Vitamin D Deficiency in Pediatric Critical Illness. J Clin Transl Endocrinol. 2014;1:170–175. 26. Özkan B, Yıldırım ZK. Rikets. Güncel Çocuk Sağlığı. 2007;5:34-41. 27. Wagner CL, Taylor SN, Hollis BW. Does Vitamin D make the world go round? Breastfeeding Medicine 2008; 3: 239-250. 28. Lucidarme O, Messai E, Mazzoni T, et al. Incidence and risk factors of vitamin D deficiency in critically ill patients: results from a prospective observational study. Intensive Care Med 2010 Sep; 36(9): 1609-1611. 29. Ponnarmeni S, Angurana SK, Singhi S et al. Vitamin D deficiency in critically ill children with sepsis. Paediatrics and International Child Health. 2015;10:1-7. 30. Aygencel G, Turkoglu M, Tuncel AF et al. Is vitamin d insufficiency associated with mortality of critically ill patients? Crit Care Res Pract 2013; 2013: 856747. 31. Matthews LR, Ahmed Y, Wilson KL, et al. Worsening severity of vitamin D deficiency is associated with increased length of stay, surgical intensive care unit cost, and mortality rate in surgical intensive care unit patients. Am J Surg 2012 Jul; 204(1): 37-43. 32. Zittermann A, Gummert JF, Börgermann J. Vitamin D deficiency and mortality. Curr Opin Clin Nutr Metab Care 2009 Nov; 12(6): 634-639. 33. Melamed ML, Michos ED, Post W et al. 25-hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med 2008 Aug 11; 168(15): 1629-1637.

Çocuk Yoğun Bakım Ünitesindeki Hastaların D Vitamini Seviyeleri

Year 2018, Volume: 10 Issue: 3, 326 - 332, 23.10.2018
https://doi.org/10.18521/ktd.319492

Abstract

Amaç: Çocuk Yoğun Bakım Ünitesinde (ÇYBÜ) yatan hastalarda serum 25-hidroksivitamin D (25-OHVitD) düzeyleri tespit edilerek D vitamini eksikliği saptananlara D vitamini desteği verilmesi; ayrıca ÇYBÜ’deki kronik hastalığı üstüne akut hastalık eklenen hastalarla sadece akut hastalığı olanların D vitamini seviyelerinin karşılaştırılması amaçlandı.

Gereç ve Yöntem: Çalışmaya Ocak 2015- Haziran 2016 tarihleri arasında İnönü Üniversitesi Turgut Özal Tıp Merkezi ÇYBÜ’ye yatırılan 1 ay-18 yaş aralığındaki 327 hasta (A grubu) ve kontrol grubu olarak sağlıklı 90 vaka (B grubu) alındı. A grubu, sadece akut hastalığı olan (A1 grubu=125 hasta) ve kronik hastalığı üzerine akut hastalık eklenen (A2 grubu=202 hasta) hastalar olmak üzere ikiye ayrıldı. Tüm vakaların demografik bilgileri, 25-OHVitD, Ca, P ve ALP düzeyleri retrospektif taranarak kaydedildi.

Bulgular: 25-OHVitD seviye ortalamaları sırasıyla A grubunda 20,9±16,4 ng/dl; A1 grubunda 25,7±17,2 ng/dl; A2 grubunda 17,9±15,2 ng/dl; B grubunda 25,9±14,4 ng/dl bulundu. D vitamini eksikliği sırasıyla A grubunda %55, A1 grubunda %43,2, A2 grubunda %62,4, B grubunda %40; yetersizliği A grubunda %16, A1 grubunda %17,6, A2 grubunda %14,9, B grubunda %20; yeterliliği A grubunda %29, A1 grubunda %39,2, A2 grubunda %22,8, B grubunda %40 bulundu. Yaşın artışı ve kronik hastalık varlığı D vitamini düzeyi üzerinde belirleyici faktörlerdi.

Sonuç: Hastaların yaşı arttıkça D vitamini eksikliği görülme sıklığının arttığı görüldü. ÇYBÜ’deki hastalarda ve özellikle de kronik hastalığı olanlarda D vitamini eksikliğinin daha sık görüldüğü tespit edildi. ÇYBÜ’de yatan ve ek olarak kronik hastalığı olan çocuklarda D vitamini eksikliğinin giderilmesinin tedavilerine katkıda bulunabileceği sonucuna varıldı.

References

  • 1. Yurdakök M. Doğa ve insan tarihinde vitamin D. Katkı Pediatri Dergisi 1990; 11:345–386. 2. Yurdakök M. Pediatrik Paleopatoloji Kemikler Mumyalar ve Çocuklar. Ankara: Öztürk Matbaası, 1986:1-86. 3. Lee DM, Rutter MK, O'Ne ill TW, et al. European Male Ageing Study Group. Vitamin D, parathyroid hormone and the metabolic syndrome in middle-aged and older European men. Eur J Endocrinol 2009;161(6):947-954. 4. Humble MB. Vitamin D, light and mental health. J Photochem Photobiol B 2010;101(2):142-149. 5. Nimitphong H, Holick MF. Vitamin D, neurocognitive functioning and immunocompetence. Curr Opin Clin Nutr Metab Care 2011;14(1):7-14. 6. Cranney A, Horsley T, O'Donnell S, et al. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess (Full Rep) 2007;(158):1-235. 7. Dobnig H, Pilz S, Scharnagl H, et al. Independent association of low serum 25-hydroxy vitamin d and1,25-dihydroxy vitamin d levels with all-cause and cardiovascular mortality. Arch In tern Med 2008;168(12):1340-1349. 8. Rippel C, South M, Butt WW, et al. Vitamin D status in critically ill children. Intensive Care Med 2012 Dec; 38(12): 2055-2062. 9. Misra M, Pacaud D, Petryk A, et al; Drug and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society: Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics 2008;122, 398-417,. 10. Gordon CM, DePeter KC, Feldman HA, et al. Prevalence of vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med. 2004;158, 531-537. 11. Rippel C, South M, Butt WW, et al. Vitamin D status in critically ill children. Intensive Care Med (2012); 38:2055–2062. 12. Singhi SC, Singh J, Prasad R. Hypocalcaemia in a paediatric intensive care unit. J Trop Pediatr 2003;49: 298-302. 13. Lee P, Eisman JA, Center JR: Vitamin D deficiency in critically ill patients. N Engl J Med, 2009a: 360, 1912-1914. 14. Desai TK, Carlson RW, Geheb MA: Parathyroid-vitamin D axis in critically ill patients with unexplained hypocalcemia. Kidney Int Suppl 1987;22: 225-228. 15. Maiya S, Allgrove J, Mok Q. Vitamin D deficiency and mortality and serious morbidity in infancy: time for action. Arch Dis Child 2006;91, A71. 16. Kumar J, Muntner P, Kaskel FJ, Hailpern SM, Melamed ML: Prevalence and associations of 25-hydroxyvitamin D deficiency in U.S. children: NHANES 2001-2004. Pediatrics 2009;124, e362-e370. 17. McNally JD, Menon K, Chakraborty P, et al. Canadian Critical Care Trials Group: The association of vitamin D status with pediatric critical illness. Pediatrics 2012;130:429-436. 18. Madden K, Feldman HA, Smith EM, et al. Vitamin D deficiency in critically ill children. Pediatrics 2012;130:421-428. 19. Lee P. Vitamin D metabolism and deficiency in critical illness. Best Pract Res Clin Endocrinol Metab 2011 Oct; 25(5): 769-781. 20. Rey C, Sánchez-Arango D, López-Herce J, et al. Vitamin D deficiency at pediatric intensive care admission. J Pediatr (Rio J) 2014 Mar-Apr; 90(2): 135-142. 21. Çiğdem H. Kritik hasta çocuklarda d vitamini eksikliğinin sikliği ve prognozla ilişkisi uzmanlık tezi. Samsun Ondokuz Mayıs üniversitesi 01.2016. 22. Güneş N. Yoğun bakim hastalarinda D vitamini düzeyi takibi uzmanlık tezi. İÜ Cerrahpaşa tıp fakültesi. 2014 23. Holick MF. Vitamin D deficiency. N Engl J Med 2007;357, 266-281. 24. Ayulo M Jr, Katyal C, Agarwal C et al. The prevalence of vitamin D deficiency and its relationship with disease severity in an urban pediatric critical care unit. Endocr Regul. 2014;48:69–76. 25. Hebbar KB, Wittkamp M, Alvarez JA et al. Vitamin D Deficiency in Pediatric Critical Illness. J Clin Transl Endocrinol. 2014;1:170–175. 26. Özkan B, Yıldırım ZK. Rikets. Güncel Çocuk Sağlığı. 2007;5:34-41. 27. Wagner CL, Taylor SN, Hollis BW. Does Vitamin D make the world go round? Breastfeeding Medicine 2008; 3: 239-250. 28. Lucidarme O, Messai E, Mazzoni T, et al. Incidence and risk factors of vitamin D deficiency in critically ill patients: results from a prospective observational study. Intensive Care Med 2010 Sep; 36(9): 1609-1611. 29. Ponnarmeni S, Angurana SK, Singhi S et al. Vitamin D deficiency in critically ill children with sepsis. Paediatrics and International Child Health. 2015;10:1-7. 30. Aygencel G, Turkoglu M, Tuncel AF et al. Is vitamin d insufficiency associated with mortality of critically ill patients? Crit Care Res Pract 2013; 2013: 856747. 31. Matthews LR, Ahmed Y, Wilson KL, et al. Worsening severity of vitamin D deficiency is associated with increased length of stay, surgical intensive care unit cost, and mortality rate in surgical intensive care unit patients. Am J Surg 2012 Jul; 204(1): 37-43. 32. Zittermann A, Gummert JF, Börgermann J. Vitamin D deficiency and mortality. Curr Opin Clin Nutr Metab Care 2009 Nov; 12(6): 634-639. 33. Melamed ML, Michos ED, Post W et al. 25-hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med 2008 Aug 11; 168(15): 1629-1637.
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Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Articles
Authors

Sait Açık

Mehmet Cengiz Yakıncı This is me

Publication Date October 23, 2018
Acceptance Date July 6, 2018
Published in Issue Year 2018 Volume: 10 Issue: 3

Cite

APA Açık, S., & Yakıncı, M. C. (2018). Çocuk Yoğun Bakım Ünitesindeki Hastaların D Vitamini Seviyeleri. Konuralp Medical Journal, 10(3), 326-332. https://doi.org/10.18521/ktd.319492
AMA Açık S, Yakıncı MC. Çocuk Yoğun Bakım Ünitesindeki Hastaların D Vitamini Seviyeleri. Konuralp Medical Journal. October 2018;10(3):326-332. doi:10.18521/ktd.319492
Chicago Açık, Sait, and Mehmet Cengiz Yakıncı. “Çocuk Yoğun Bakım Ünitesindeki Hastaların D Vitamini Seviyeleri”. Konuralp Medical Journal 10, no. 3 (October 2018): 326-32. https://doi.org/10.18521/ktd.319492.
EndNote Açık S, Yakıncı MC (October 1, 2018) Çocuk Yoğun Bakım Ünitesindeki Hastaların D Vitamini Seviyeleri. Konuralp Medical Journal 10 3 326–332.
IEEE S. Açık and M. C. Yakıncı, “Çocuk Yoğun Bakım Ünitesindeki Hastaların D Vitamini Seviyeleri”, Konuralp Medical Journal, vol. 10, no. 3, pp. 326–332, 2018, doi: 10.18521/ktd.319492.
ISNAD Açık, Sait - Yakıncı, Mehmet Cengiz. “Çocuk Yoğun Bakım Ünitesindeki Hastaların D Vitamini Seviyeleri”. Konuralp Medical Journal 10/3 (October 2018), 326-332. https://doi.org/10.18521/ktd.319492.
JAMA Açık S, Yakıncı MC. Çocuk Yoğun Bakım Ünitesindeki Hastaların D Vitamini Seviyeleri. Konuralp Medical Journal. 2018;10:326–332.
MLA Açık, Sait and Mehmet Cengiz Yakıncı. “Çocuk Yoğun Bakım Ünitesindeki Hastaların D Vitamini Seviyeleri”. Konuralp Medical Journal, vol. 10, no. 3, 2018, pp. 326-32, doi:10.18521/ktd.319492.
Vancouver Açık S, Yakıncı MC. Çocuk Yoğun Bakım Ünitesindeki Hastaların D Vitamini Seviyeleri. Konuralp Medical Journal. 2018;10(3):326-32.