Women who take high doses of vitamin D during pregnancy have a greatly reduced risk of complications, including gestational diabetes, preterm birth, and infection, new research suggests. In pregnancy there is enhanced intestinal calcium absorption. Vitamin D toxicity is manifested through hypercalcaemia and hypercalciuria. Therefore, there is a hypothetical concern that when secondary hyperparathyroidism follows vitamin D deficiency, Calcium given with vitamin D may be associated with temporary hypercalcaemia. However, this is self-limiting due to the associated hungry bone and has not been demonstrated to represent a clinical problem.
THANKS for the update Ma, M It is really important to prevent vitamin D- deficiency at Pre- natal level because it is really alarming that incidence of vitamin D- deficiency in india,is as high as 70 - 90 % and up to 100 % in complete vegetarians . As Vitamin D- deficiency is associated with so many disorders it is really important to maintain its levels. Diseases related with vitamin D deficiency are Osteoporosis Cardiovascular diseases Autoimmune diseases. Chronic infections. Inflammatory bowel disease Malignancy Cognitive impairment and so on
Yes madam standard dosage of vitamin D sh6 be given in anc. As per reports it is better to increase on 24 weeks
Very nice infomation for baby born and lactating mother.very helpful.
Informative post, Thanks for sharing ma'am.
Very informative mam
VD3 supplementation in ANC improve NOT just improve health of baby but very beneficial to mother's health. It reduces both antenatal nd postnatal complications. Thanks for sharing mam.
Nice information sir
Nice update ma'am
Cases that would interest you
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HYPERPARATHYROIDISM. The parathyroid glands are responsible for maintaining the extracellular calcium concentration . Hyperparathyroidism is a disease characterised by excessive secretion of parathyroid hormone,an 84 -amino acid polypeptide hormone. The main effects of parathyroid hormone are to increase the concentration of plasma calcium by *Increasing the release of calcium and phosphorus from the bone matrix. *Increasing calcium reabsorption by the kidneys. *Increasing renal production of 1,25-dihydroxy vitamin D3 (calcitriol ) which increases intestinal absorption of calcium. ANATOMY. Usually four parathyroids are situated posterior to the Thyroid gland.They are right and left superior and inferior glands. The inferior glands are derived from third pharyngeal pouch and migrate down. The superior glands are derived from fourth pharyngeal pouch and usually found just superior to the intersection of the inferior thyroid artery and recurrent laryngeal nerve. There are three types of hyperparathyroidism. Primary hyperparathyroidism. Secondary hyperparathyroidism. Tertiary hyperparathyroidism. PRIMARY HYPERPARATHYROIDISM. Primary hyperparathyroidism is unregulated overproduction of parathyroid hormone (PTH ) resulting in abnormal calcium homeostasis. The mean age at diagnosis is 52 -56 years. Female -to -male ratio is 3 :1. CAUSE. 85 % of cases -caused by single adenoma. 15 % of cases - caused by multiple adenomas or hyperplasia. Rarely,it is caused by parathyroid carcinoma. Familial cases can occur due to multiple endocrine neoplasia syndromes. , Hyperparathyroid - jaw tumour syndrome Familial isolated hyperparathyroidism (FIHPT ) PATHOPHYSIOLOGY. The chronic excessive resorption of calcium from bone due to excessive PTH can result in Osteopenia. Osteitis fibrosa cystica. Sub periosteal resorption of distal phalanges. Tapering of distal clavicles. Salt and pepper appearance of the skull. Brown tumours of the long bones. Other symptoms of hyperparathyroidism are. THE SYMPTOMATOLOGY OF HYPERPARATHYROIDISM ARE RENAL STONES. PAINFUL BONES. ABDOMINAL GROANS. PSYCHIC MOANS. OTHER SYMPTOMS OF HYPERPARATHYROIDISM. They are due to hypercalcemia.They are Muscle weakness. Fatigue. Volume depletion. Nausea and vomiting. Coma and death. Neuropsychiatric manifestations like depression and confusion. Peptic ulcer disease and pancreatitis. CLINICAL PRESENTATION. BONES,STONES,ABDOMINAL GROANS AND PSYCHIC MOANS. SKELETAL MANIFESTATIONS. Osteitis fibrosa cystica characterised by increased generalized bone resorption,particularly involving the phalanges causing subperiosteal resorption,and skull gives radiological appearance of salt and pepper skull. Renal manifestations are polyuria,kidney stones,hypercalcuria and nephrocalcinosis. Gastrointestinal manifestations are anorexia,nausea , vomiting,abdominal pain,constipation,peptic ulcer disease and pancreatitis. Neuromuscular and psychological manifestations are proximal myopathy,weakness,easy fatigability,depression,inability to concentrate and memory problems. Cardiovascular manifestations are hypertension,bradycardia,shortened QT interval,and left ventricular hypertrophy. PHYSICAL EXAMINATION FINDINGS ARE USUALLY NON CONTRIBUTORY. LABORATORY STUDIES. TESTING OF INTACT PARATHYROID HORMONE IS THE CORE OF THE DIAGNOSIS.AN ELEVATED INTACT PARATHYROID HORMONE WITH AN ELEVATED IONISED SERUM CALCIUM LEVEL IS DIAGNOSTIC OF PRIMARY HYPERPARATHYROIDISM. A 24 HOUR URINARY CALCIUM MEASUREMENT IS ESSENTIAL TO RULE OUT FAMILIAL HYPOCALCIURIC HYPERCALCEMIA. ULTRASOUND of the neck is a safe procedure for localization of abnormal parathyroid glands. NUCLEAR MEDICINE SCANNING WITH RADIOLABELLED SESTAMIBI is used to detect abnormal parathyroid tissues in which the radionuclide concentrates. 4D - CT SCAN AND MRI are also used to locate abnormal parathyroid glands. TREATMENT. SURGICAL EXCISION OF ABNORMAL PARATHYROID GLANDS IS THE ONLY PERMANENT,CURATIVE TREATMENT FOR PRIMARY HYPERPARATHYROIDISM. Surgical treatment is offered to all patients with symptomatic disease.The indications for surgery are *One mg /dl above the upper limit of reference range for serum calcium. *24 hour urinary calcium excretion is >> 400 mg. *A 30 %reduction in creatinine clearance. *Bone mineral density T score <<2.5. *Age << 50 years. Patients with asymptomatic hyperparathyroidism are monitored with serum calcium,serum creatinine and annual bone mineral density. Other management measures are. Moderate daily elemental calcium intake of 1000 mg Vitamin D intake. Maintain good hydration. Regular exercise. Avoidance of immobilisation. Avoid medications like thiazides,diuretics and lithium. Treatment with BIPHOSPHONATES - ALENDRONATE ,has been shown to improve BMD SECONDARY HYPERPARATHYROIDISM. Secondary hyperparathyroidism is the overproduction of parathyroid hormone secondary to a chronic abnormal stimulus for its production. Most common cause is CHRONIC RENAL FAILURE. Other causes are. Vitamin D deficiency. LABORATORY STUDIES. Serum level of parathyroid hormone,calcium,phosphorus and 25 - hydroxy vitamin D are measured. Parathyroid hormone -elevated. Calcium -low normal calcium. Phosphorus -high in renal insufficiency. - low in vitamin D deficiency. Vitamin D -Normal ->>> 30 ng /ml. - mild deficiency 21 - 29 ng /ml. -deficiency <<< 20 ng / ml. TREATMENT. Unlike primary hyperparathyroidism,MEDICAL MANAGEMENT IS THE MAINSTAY OF TREATMENT FOR SECONDARY HYPERPARATHYROIDISM. Correcting vitamin D deficiency. Dietary phosphate restricted. Phosphate binders are used. Calcium supplementation <<2 g/d TERTIARY HYPERPARATHYROIDISM. This is a state of excessive secretion of parathyroid hormone after long standing secondary hyperparathyroidism and resulting in hypercalcemia. Finally one word. Primary hyperparathyroidism. Calcium increased. PTH increased. Urine calcium increased. Phosphate reduced. Secondary hyperparathyroidism. Calcium reduced. PTH increased. Tertiary hyperparathyroidism. Calcium increased. PTH increased.Dr. Suvarchala Pratap18 Likes10 Answers
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58Y/M. CAME TO MY OPD WITH COMPLAINTS OF SEVERE LEFT SIDE LOIN PAIN WITH VOMITING, ,H/O -GASTRITIS, ,,NO FEVER, ,LM, ,NO BURNING IN URINE, ,TPR /BP --WNL, ,BELOW IS THE SCAN OF (A+P),,,SO DEAR CUROFIANS PLZZ GIVE UR OPINION REGARDING THIS, ,THANKS, ,REGARDS, ,DR RAJ PANDEY MISHRADr. Raj Pandey Mishra3 Likes7 Answers
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The Clinical Importance Of Vitamin D ( Cholecalciferol ) Last Sunday, I gave a lecture on this topic to a group of doctors and I would like to share some of that information on this forum ! This topic will be useful for those who are not aware of the important role of Vitamin D in our each body system, for those of you, who are aware, please consider this as a revision. We are familiar with the important role of Vitamin D in Calcium absorption and bone metabolism. Now let's go beyond these effects. The widening range of therapeutic applications available for Cholecalciferol have come from the recent research data , as both a Vitamin and a pro-hormone. Recent data highlights the physiological requirement for Vitamin D in adults may be as high as 5000IU/day, which is less than half of the >10000IU that can be produced endogenously with full body sun exposure. Vitamin D receptors are not only seen in the gut and bone, but also in brain, breast, prostrate and lymphocytes and recent research suggests that higher Vitamin D levels provide protection from DM, Osteoporosis, Osteoarthritis, Hypertension, CVD, Metabolic syndrome, Depression, cancers of the breast, prostrate and colon and several autoimmune diseases. We should be assessing the Vitamin D status and treating with oral Vitamin D supplements , as a routine component of clinical and preventive medicine Periodic assessment of Serum 25OH-vitamin D and serum Calcium helps to ensure Vitamin D levels are sufficient and safe for good health and disease prevention. We shall concentrate our attention, more on on the use of Vitamin D in the management of T2DM, osteoporosis, Osteoarthritis, Hypertension, CVD, metabolic syndrome, Multiple sclerosis, PCOD, Musculoskeletal pain,depression, epilepsy, and also in the prevention of cancer and T1DM. Supplementation of vitamin D is a must in all age groups, infants, children, adults and during pregnancy and lactation. CVD Deaths from CVD are more common in winter, more common at higher latitudes and more common at lower altitudes, observations that are consistent with vitamin D insufficiency. The risk of A heart attack is twice as high for those with 25(OH)D levels < 34 ng/ml than for those with vitamin D status above this level. Patients with CCF were recently found to have markedly lower levels of vitamin D than controls. HYPERTENSION It has long been known that BP is higher in winter than in the summer, increases at a greater distances from the equator and is affected by skin pigmentation - all observations consistent with a role of vitamin D in regulating BP. When patients with HT were treated with ultraviolet light three times a week for 6 weeks, their vitamin D levels increased by 162 % and their BP fell significantly. Even small amounts of oral cholecalciferol 800IU for 8 weeks lowered both BP and HR. T2DM Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction in diabetic young adults who are apparently healthy. Healthy adults with higher serum 25( OH)D levels had significantly lower 60 minutes, 90 minutes, and 120 minutes PPBS levels and significantly better insulin sensitivity than those who were vitamin D deficient.. One interesting observation was that Metformin improved insulin sensitivity by 13% and higher vitamin D status correlated with a 60% improvement in insulin sensitivity. OSTEOARTHRITIS We know that vitamin D helps in prevention and treatment of osteoporosis, but few know that the progression of osteoarthritis is lessened by adequate blood levels of vitamin D. Framingham data shows that osteoarthritis of knee progressed more rapidly in those with 25(OH)D levels < 36 ng/ml. MULTIPLE SCLEROSIS This autoimmune/ inflammatory disease is notably rare in sunny equatorial regions and becomes increasingly prevalent among people who live farther from the equator and/or who lack adequate sun exposure .Daily supplementation with approximately 1000mg calcium, 600mg magnesium and 5000 IU vitamin D ( from cod liver oil ) for upto 2 years and found a reduction in number of exacerbations and an absence of adverse effects. PREVENTION OF T1DM This is generally caused by autoimmune/inflammatory destruction of pancreatic beta cells. In a study with >1000 participants, supplementation in infants < 1yr of age and children with 2000 IU of vitamin D reduced the incidence of T1DM by approximately 80%. DEPRESSION Seasonal affective disorder ( SAD ), a subset of depression characterized by the onset or exacerbations of melanocholia during winter months, when bright light, sun exposure and serum 25(OH)D are reduced. A dose of 10000IU of vitamin D was found superior to light therapy in treatment of SAD after 1 month, also in another study supplementation with vitamin D 400 - 800 IU per day improved mood witin five days of treatment. EPILEPSY Seizures can be the presenting manifestation of vitamin D deficiency. Hypovitaminosis D decreases the threshold for and increases the incidence of seizures and several anticonvulsant drugs interfere with the fformation of calcitriol in the kidney and further reduces the calcitriol levels via induction of hepatic clearance. Therefore anticonvulsants may lead to iatrogenic seizures by causing iatrogenic Hypovitaminosis D. Conversely, supplementation with 4000-16000 IU per day of vitamin D helps to reduce seizure frequency, a study finding ! MIGRAINE HEADACHES Calcium clearly plays a role in the maintenance of vascular tone and coagulation, both of which are altered i patients with migraine. In a study, a daily supplementation with 1200 mg of calcium and 1200- 1600 IU of vitamin D in women with vitamin D deficiency showed a reduction in frequency, duration and severity of menstrual migraine headaches. PCOD Surprisingly, this disease is seen only in humans and is classically characterized by polycystic ovaries, amenorrhea, hirsuitism, IR and obesity. Studies have shown that calcium is essential for oocyte activation and maturation. Vitamin D deficiency is highly prevalent in these patients. Thus a supplementation of 1500 mg of calcium per day and 50000 IU of vitamin D on a weekly basis helps in normalization of menstruation and/or fertility. MUSCULOSKELETAL PAINS Patients with non traumatic, persistent Musculoskeletal pain show a significant high prevalence of overt vitamin D deficiency .In a study, patients with non specific low back pain , good results were obtained with supplementation with 5000- 10000 IU of vitamin D per day after 3 months. I hope, after this reading you might be convinced of importance of vitamin D . Let us add vitamin D in treatment, more often !Dr. Chakradhar Nannapaneni26 Likes19 Answers
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44 yr old lady ,not a k/c/o DM/HT/Dyslipidemia c/o dyspnoea on exertion for the past 3 yrs along with 10% weight gain. On examination bilateral pitting pedal edema present more so on the right leg (photo attached) vitals are stable and all the systemic examinations normal. Also attaching the photo of her dry,coarse skin,mostly due to hypothyroidism P.s:Can pedal edema be severe enough to cause medial deviation of the toes??(photo attached) If not what are the reasons for it??Dr. Vaibhav Suresh5 Likes25 Answers
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40/f has right flank pain since 15 days with burning micturition. no fever/hematuria no h/o left loin pain hypothyroidism (TSH: 11, on eltroxin 50ugOD) xray image given how to proceed in this case? hypothyroidism management??Dr. Ashish Parikh5 Likes26 Answers