Clinical Trial of Vitamin D₂ vs D₃ Supplementation in Critically Ill Pediatric Burn Patients

Abstract

The high incidence of low serum D25 levels 1 year following serious thermal injury indicates prolonged compromise. Continued treatment with vitamin D beyond the acute phase postburn is recommended to counteract the trajectory of abnormal serum levels and associated morbidity.

Interactions of Phosphate Metabolism With Serious Injury, Including Burns

“…Evidence is emerging that the calcemic response to burn injury is different between children and adults. Our studies and those of Gottschlich and colleagues have indicated that pediatric patients develop hypocalcemic hypoparathyroidism after a burn injury, whereas studies of adults indicate that patients severely burned are either normocalcemic or mildly hypercalcemic and are euparathyroid or mildly hyperparathyroid . These data suggest that whereas pediatric burn patients experience an upregulation of the parathyroid CaSR as described above, adult burn patients do not.…”

Investigation of Bone Health Subsequent to Vitamin D Supplementation in Children Following Burn Injury

“…All were previously enrolled in a randomized vitamin D supplementation trial. The details of the study design and the effect of intervention on vitamin D biomarkers have been published separately 14 . In brief, patients were randomized to receive 100 IU/kg/d enteral vitamin D2, D3, or placebo during their acute burn course.…”

“…Beginning 22 months after enrollment of the final study patient, 14 attempts (3 phone calls maximum) were made to contact the parent or primary caregiver of each study participant to ascertain the incidence of long bone fracture since the acute injury. Fracture outcome was differentiated between the vitamin D2, D3, and placebo supplementation groups.…”

“…10 Hypovitaminosis D has been documented during the postburn period. [12][13][14] Multiple physiological roles are supported by vitamin D, including modulation of cell growth, [15][16][17] neuromuscular [18][19][20][21] and immune function, 16,[22][23][24][25] reduction of inflammation, 26,27 and growing evidence of a role in the prevention and treatment of diabetes, [28][29][30] cancer, [31][32][33][34][35] and multiple sclerosis. [36][37][38][39][40] However, vitamin D is most commonly known for its role in bone metabolism [41][42][43][44][45] because it promotes calcium absorption and assists with hemodynamic concentration of calcium and phosphate, enabling bone mineralization.…”

Long-Term Effects of Severe Burn Injury on Bone Turnover and Microarchitecture

“…Thus, the CaSR is both promoter of and responder to the inflammation by changing levels of PTH. The observed wave pattern of iPTH with relatively stable calcium levels over time reflects different phases of inflammation and response, independent of cholecalciferol supplementation in adult and pediatric patients . Hypocalcemia is frequent in the early phase after burn injury and contributes substantially to the difficulty in determining nutrient requirements in this pathologic state.…”