L15Vitamin D Deficiency in Institutionalised HD Patients

BackgroundElderly dementia patients are prescribed cholecalciferol (vitamin D) when institutionalized in one of our wards. We follow guidelines from the Dutch Health Council, which are evidence-based. No large-scale research, or guidelines are available on vitamin D deficiency and suppletion in institutionalized patient with HD, Korsakov's syndrome or Acquired Brain Injury. Chel et alfound high prevalence of vitamin D deficiency and insufficiency among 28 patients in a Dutch Skilled Nursing Facility.MethodIn 21 institutionalized HD patients we did blood tests to determine the level of vitamin D (serum 25(OH)D level). In these patients, blood samples had to be drawn for other indications, and the vit D level was assessed at the same time.AimAssess the prevalence and level of vitamin D deficiency in our institutionalized HD patients.ResultsWe found deficiency in all patients included. Mean was 25 nmol/l. Range was 3 - 51 nmol/l (rev. 50-150 nmol/l). Some of these patients are on a high kcal diet, adding drinks/meal replacements with added vitamins to their daily intake.ConclusionsVitamin D deficiency is common in advanced HD.RecommendationsWe recommend lab tests on admission, and prescribe monthly vitamin D to all HD patients with deficiency. In severe deficiency a weekly dose is given for three months. Contra indications (sarcoidosis, hyperkalemia, hyperparathyroidism) should be taken into account by prescribers. Exposure to the sun on a daily basis for at least 30 minutes is not always realistic, but advisable.ReferencesChel VG, Ooms ME, van der Bent J, Veldkamp F, et al. High prevalence of vitamin D deficiency and insufficiency in patients with manifest Huntington disease: An explorative study. Dermatoendocrinol2013; 5(3):348-51