On 30th March 2020, a 57‐year‐old male patient presented to the Emergency Department with a 6‐day history of cough, persistent fevers and worsening dyspnoea. His only known comorbidity was hypertension, managed with amlodipine and an angiotensin converting enzyme inhibitor. On admission, he was tachypnoeic and in severe hypoxic respiratory failure with dangerously low peripheral oxygen saturations (SpO 2 ) 83% on 15L oxygen. Chest radiographic changes were consistent with COVID‐19 infection and demonstrated bilateral changes with diffuse airspace shadowing with more confluence in the lower zones (Figure 1A).

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Introduction Inflammatory bowel disease (IBD) patients are at risk of micronutrient deficiencies, including vitamin D. There is increasing evidence that vitamin D deficiency has a negative impact on disease activity. This study aims to determine the vitamin D status of a sub-set of IBD patients at a University Hospital and to evaluate the effectiveness of oral vitamin D treatment in correcting the deficiency. Methods All IBD patients with recorded serum vitamin D levels measured in 2011 were identified. Vitamin D deficiency was determined as combined vitamin D2 and D3 plasma levels lower than 52 nmol/L and treatment response was assessed up to 4–6 months after initiation of oral treatment. Oral vitamin D supplementation was classified as ‘low dose’ when patients prescribed daily 800 units of vitamin D2 or D3 and classified as ‘high dose’ when given either 100’000 units once only or 50’000 units per week for 6 weeks. Abstract PTU-078 Table 1 Plasma vitamin D response to differing doses of oral treatment in CD and UC Subjects Vitamin D deficient (%) Treated orally + follow up Vitamin D available % increase in plasma vitamin D High dose Rx % increase in plasma vitamin D Low dose Rx % increase in plasma vitamin D All subjects 205 95 (46) 32 115 24 150 8 34 UC 70 35 (50) 11 100 8 167 3 47 All CD 135 60 (44) 21 116 16 150 5 29 Ileocolonic CD 45 20 (44) 9 132 7 156 2 13 Colonic CD 36 15 (42) 5 64 3 114 2 46 Small bowel -CD 54 25 (46) 7 145 6 173 1 14 Results 205 IBD patients with plasma vitamin D measurements were identified, 95 (46%) were found to be vitamin D deficient. There was no significant difference in the prevalence of vitamin D deficiency between the Crohn’s disease (CD) and ulcerative colitis (UC) patients, 44% vs 50%, (p = 0.449). 50/95 (52.6%) patients received treatment and 32 treatment episodes had follow up vitamin D status measurement within 4–6 months. Those who received ‘high dose’ oral vitamin D demonstrated an increase in vitamin D levels of 150% after treatment compared to an increase of 34% in those put on ‘low dose’ vitamin D supplement (p = 0.001). There was no significant difference in treatment response between CD and UC (p = 0.874) (see table 1). Conclusion There were no differences in plasma vitamin D concentrations between patients with CD and UC. Oral vitamin D replacement is an effective treatment for vitamin D deficiency in IBD patients and appears to be dose responsive; irrespective of whether patient have UC or CD (including small bowel disease). The optimal dose of oral vitamin D supplementation is yet to be determined, but higher doses are significantly more effective. Disclosure of Interest None Declared

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