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  • Category: Orthopedics

    Treatment for vitamin D3 deficiency?

    Vitamin D3(Cholecalciferol): One of my relative has been suffering from pain in bones on doing simple household works and more when she carries her infant in arms. Initially it was assumed due to hypothyroidism, which was found positive, following which regular medication are being taken. However when the pain or tenderness in bones still persisted even after thyroid medication, then doctor diagnosed it to be due to vitamin D3 deficiency, after a test.

    The doctor then prescribed ergocalciferol 6L IU, to be taken as intramuscular injection. However, the doctor has asked to take it orally instead of injection. This is where my question comes.

    Is it okay to take ergocalciferol orally?
    Does it carry any advantages or disadvantages over parenteral(i.m) route?

    Vitamin D is produced by the effect of sunlight on skin, apart from diet. Since
    she stays in dubai, where temperature is usually above 30 degree celcius and thus people avoid being outdoors during day time, leading to this deficiency.
    I'm a medical student, so know the basics about it but just want to confirm from a experienced doctor in ISC. Request the doctor members of ISC to kindly help me with my query.
  • Answers

    2 Answers found.
  • Vitamin D is helps in calcium absorption. Ergocalciferol is used to treat hypoparathyroidism, rickets, hypophosphatemia, etc. Its very important to correct her levels now to prevent problems like osteoporosis (which leads to weak bone & easy fractures) in future
    . Ask her to increase intake of food containing calcium & vitamin D such as-
    . Milk, milk products, ragi, curds, eggs, sea foods, fish oil, nonvegetarian food, etc. Adequate dietary calcium is needed for maximum benefits of vitamin D
    . Sunlight exposure during early morning hours is useful as vitamin D is synthesized in body. Ask her to go for a morning walk without applying sunscreen lotion.
    . Some patients don't like repeated injections. So the doctor might have suggested oral route. Ask her to swallow capsule as whole & not to crush or chew it. Oral absorption is good if she doesn't have hepatic, biliary, or gastrointestinal disease
    . Calcium & vitamin D tablets (e.g. shelcal) are available in market.
    . She has an infant. This suggests that most probably she has developed vitamin D deficiency during pregnancy which is due to inadequate intake as compared to excess demand by growing baby in uterus & during breastfeeding (lactational period). Ergocalciferol can pass into breast milk. She should do regular vitamin D levels, blood calcium and phosphate levels to avoid overdosing. It also helps in adjusting the dose. Correction of her vitamin D levels is important as it will help in preventing rickets in infant. Thyroid hormones also have a role in body metabolism
    . Vitamin D metabolites increase the active absorption of calcium and phosphorus in the small intestine
    . Adult Dose for Vitamin D Deficiency:
    . 1000 units orally once a day. In patients with malabsorption of vitamin D, the dose is 10,000 units IM once a day or 10,000 to 100,000 units once a day orally depending on severity.
    . Vitamin D drops may be needed for her infant as infant will get inadequate through breast milk
    . Medicines like orlistat, mineral oils can reduce vitamin D absorption. So keep an interval of 2-3 hours between the 2 drugs
    . Side effects of Ergocalciferol-
    . Weight loss
    . Muscle pain,
    . Nausea and vomiting
    . Constipation,
    . Shortness of breath
    . Chest pain
    . Weakness,
    . Metallic taste in mouth
    Ask her to inform doctor if she gets an allergic reaction to vitamin D
    . Monitoring of the infant's serum calcium levels is required if she is breastfeeding & taking calcium, vitamin D supplements. This is to prevent hypercalcemia in infant
    . Hypervitaminosis D with hypercalcemia is a known fact with various effects on body & she should be aware of its signs & symptoms

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