It's important to note that a majority of patients with vitamin D deficiency are asymptomatic; they don't experience any acute symptoms. For the specifically acute symptoms, there can be some chronic findings later, but for the most part, the majority of patients with vitamin D deficiency don't experience any acute symptoms, and if they are symptomatic, a lot of it has to do with issues with low calcium levels. In some cases, the signs and symptoms of hypocalcemia include perioral tingling, a tingling sensation around the mouth that occurs when the facial nerve is continuously tapped and the facial nerve doesn't relax properly. Another sign that occurs is when a blood pressure cough is inflated on someone's arm and that patient has a carpal pedal spasm. Hypocalcemic state leads to an upregulation of the activity of the parathyroid glands, leading to secondary hyperparathyroidism. Because there's not enough vitamin D around to absorb calcium from the gastrointestinal system, we get low levels of calcium. Calcium actually prevents the release of parathyroid hormone, so if we have low levels of calcium, this can lead to an upregulation of parathyroid hormone release and this is secondary hyperparathyroidism. This increase in parathyroid hormone leads to the reabsorption of calcium and phosphate from the bone. It also does other functions on the kidneys as well, but right now we're just going to focus on the bone. It helps to dissolve bone and release calcium and phosphate. Because the body is low in calcium, parathyroid hormone goes to the bone and releases calcium from the bone. What this does is cause bone pain, can cause allergies, muscle aches can lead to arthralgias, joint aches can cause fasciculation, and muscle twitching can cause weakness. Hyperparathyroidism causes bone resorption, which can cause problems.
Osteomalacia is the softening of the bone. We can see this in children. If there's vitamin D deficiency in children where they're not able to actually develop and form their bones properly, we can get rickets, and this again occurs in children.
In osteoporosis, we see a normal bone and then we see it becoming very erotic, so it becomes weaker and there's an increased risk of fractures, so it's an increased risk of falls and fractures and oftentimes these findings can be evidence of chronic subclinical vitamin D deficiency. So subclinical vitamin D deficiency really means that they have vitamin D deficiency and they're not really having acute symptoms of it, but all the while their bones are kind of getting weaker, they're having decreased bone mineralization and then eventually they end up having issues with bone health, so again, it can be evidence that there's been some chronic ongoing subclinical vitamin D deficiency. It's been shown that vitamin D deficiency is associated with an increased risk of various infectious diseases, and in particular, acute respiratory tract infections seem to occur more frequently in those with vitamin D deficiency. It has been shown that patients who are vitamin D deficient are at an increased risk of certain infectious diseases. One of those is tuberculosis. Another one is influenza, and another is bacterial vaginosis. These are some of the infections that patients can be at an increased risk for if they have vitamin D deficiency. Some other clinical features of vitamin D deficiency can occur in children, and these include developmental delay, lethargy, and irritability. Then there's increasing evidence that vitamin D deficiency is associated with an increased risk of depression, obesity, diabetes, heart disease, and some types of cancer, so there's a lot of research to be done with regards to vitamin D deficiency and some of these other conditions as well. Vitamin D deficiency is associated with many different conditions, and each of these conditions requires Vitamin D deficiency to be diagnosed by looking at 25 hydroxyvitamin D levels, so we're going to talk about what the cutoffs are for the diagnosis. So the levels for diagnosing vitamin D deficiency are as follows, and while there is some debate about the optimum levels of vitamin D, these are the numbers that have been stated, so mild vitamin D deficiency is when 25 hydroxyvitamin D levels are less than 20 or less than 30. sources say 30 nanograms per milliliter is a moderate deficiency when 25 hydroxyvitamin D levels are less than 10 nanograms per milliliter and a severe deficiency when 25 hydroxyvitamin D levels are less than 5 nanograms per milliliter. These are the numbers that classify mild-moderate and severe vitamin D deficiency, so how is vitamin D deficiency treated? It's all about replacing vitamin D, but you might be asking which one should be used: vitamin D3 or vitamin D2? Vitamin D3 has actually been shown to quickly replenish levels of vitamin D compared to vitamin D2, so vitamin D3 is most often used and the amount of supplementation of vitamin D differs depending on age and risk factors.
You must be logged in to post a comment.