Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Acute fluid shifts influence the assessment of serum vitamin D status in critically ill patients. | Krishnan et al. Critical Care 2010 14 R216 http content 14 6 R216 KS CRITICAL CARE RESEARCH Open Access Acute fluid shifts influence the assessment of serum vitamin D status in critically ill patients 1 12 11 3 14 Anand Krishnan Judith Ochola Julie Mundy Mark Jones Peter Kruger Emma Duncan Bala Venkatesh Abstract Introduction Recent reports have highlighted the prevalence of vitamin D deficiency and suggested an association with excess mortality in critically ill patients. Serum vitamin D concentrations in these studies were measured following resuscitation. It is unclear whether aggressive fluid resuscitation independently influences serum vitamin D. Methods Nineteen patients undergoing cardiopulmonary bypass were studied. Serum 25 OH D3 1a 25 OH 2D3 parathyroid hormone C-reactive protein CRP and ionised calcium were measured at five defined timepoints T1 -baseline T2 - 5 minutes after onset of cardiopulmonary bypass CPB time of maximal fluid effect T3 - on return to the intensive care unit T4 - 24 hrs after surgery and T5 - 5 days after surgery. Linear mixed models were used to compare measures at T2-T5 with baseline measures. Results Acute fluid loading resulted in a 35 reduction in 25 OH D3 59 16 to 38 14 nmol L P and a 45 reduction in 1a 25 OH 2D3 99 40 to 54 22 pmol L P and i Ca P with elevation in parathyroid hormone P . Serum 25 OH D3 returned to baseline only at T5 while 1a 25 OH 2D3 demonstrated an overshoot above baseline at T5 P . There was a delayed rise in CRP at T4 and T5 this was not associated with a reduction in vitamin D levels at these time points. Conclusions Hemodilution significantly lowers serum 25 OH D3 and 1a 25 OH 2D3 which may take up to 24 hours to resolve. Moreover delayed overshoot of 1a 25 OH 2D3 needs consideration. We urge caution in interpreting serum vitamin D in critically ill patients in the context of major resuscitation and would advocate repeating the measurement once the effects
