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Vitamin D in acute stress and critical illness

Quraishi, Sadeq A.a; Camargo, Carlos A. Jrb

Current Opinion in Clinical Nutrition & Metabolic Care: November 2012 - Volume 15 - Issue 6 - p 625–634
doi: 10.1097/MCO.0b013e328358fc2b
MICRONUTRIENTS: Edited by Gil Hardy and Henry Lukaski

Purpose of review The pleotropic effects of vitamin D on chronic diseases have received significant attention; however, its role in acute illness is less understood. The purpose of this review is to summarize the current evidence regarding the role of vitamin D in acute stress and critical illness.

Recent findings 25-Hydroxyvitamin D levels may affect risk of developing acute illnesses (e.g. respiratory infections), and low concentrations are associated with unfavorable outcomes during critical care. Inflammatory changes alone do not explain the observed deterioration in vitamin D status following acute stress. Hemodilution, interstitial extravasation, decreased synthesis of binding proteins, and renal wasting of 25-hydroxyvitamin D, all appear to play a more significant role in the regulation of vitamin D status during critical illness.

Summary Single-point assessments of 25-hydroxyvitamin D following acute stress may provide an inaccurate assessment of vitamin D status. In such cases, measurement of binding proteins and free vitamin D metabolites may be essential to create a more realistic approximation of vitamin D status. Variations in patient responses to acute stress and critical illness may depend not only on the degree of systemic vitamin D insufficiency, but also on the individual tissue requirements.

aDepartment of Anesthesia, Critical Care and Pain Medicine

bDepartment of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Massachusetts, USA

Correspondence to Sadeq A. Quraishi, MD, MHA, Assistant Professor of Anaesthesia, Harvard Medical School, Assistant Anesthetist, Massachusetts General Hospital, Department of Anesthesia, Critical Care, and Pain Medicine, 55 Fruit Street, GRJ 402, Boston, MA 02114, USA. Tel: +1 617 643 5430; fax: +1 617 643 4502; e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.