Hypovitaminosis D in acutely injured pediatric burn patients.
OBJECTIVE
The prevalence of vitamin D insufficiency, its etiology, and associated sequelae among acutely injured burn patients is unknown.


OBJECTIVE
This study assessed vitamin D and endocrine status, as well as the effect of anabolic agents, in pediatric patients who had sustained burns in excess of 25% total body surface area (TBSA).


METHODS
Sixty-nine patients with a mean TBSA burn of 50.6+/-2.2% (range 27% to 94%) and full thickness injury of 41.3+/-3.0% (range 0% to 94%) were studied. Subjects ranged in age from 0.6 to 18 years (mean, 5.8+/-0.6 years). Main outcome measures Blood samples were obtained for serum 25-hydroxyvitamin D (D25), 1,25-dihydroxyvitamin D (D1,25), albumin, cortisol, triiodothyronine (T3), tetraiodothyronine (T(4)), thyroid stimulating hormone (TSH), and parathormone (PTH).


RESULTS
Two hundred eighty morning blood samples of D25 and D1,25 demonstrated that 45% and 26.2% were low and 8.9% and 11% were very low, respectively. At least one low D25 or D1,25 level occurred in 62.3% of all subjects. Very low levels were noted in 23.2% of all patients. There was an increased incidence of hyperparathyroidism in patients with very low serum D25. Vitamin D25 and D1,25 levels were lower in subjects with larger burns or inhalation injury, as well as those treated with thyroxine or oxandrolone. Serum albumin, cortisol, T(4), and TSH were not correlated with concentration of vitamin D.


CONCLUSIONS
Demonstration of a high incidence of low serum vitamin D indicates vitamin D status may be significantly compromised in burned children. It is unclear why vitamin D deficiency exists in this population. The most effective way to improve vitamin D status remains elusive at this time.
Gottschlich
Michele M
MM
Shriners Hospitals for Children, Cincinnati, OH 45229, USA. mgottschlich@shrinenet.org
Mayes
Theresa
T
Khoury
Jane
J
Warden
Glenn D
GD
D000293:Adolescent; D045930:Anabolic Agents / Q000627:therapeutic use; D002056:Burns / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D004872:Ergocalciferols / Q000627:therapeutic use; D013006:Growth Hormone / Q000627:therapeutic use; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D015994:Incidence; D007223:Infant; D010074:Oxandrolone / Q000627:therapeutic use; D010281:Parathyroid Hormone / Q000097:blood; D015995:Prevalence; D012709:Serum Albumin / Q000032:analysis; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood / Q000627:therapeutic use; D015599:Trauma Severity Indices; D014284:Triiodothyronine / Q000097:blood; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology
D045930:Anabolic Agents; D004872:Ergocalciferols; D010281:Parathyroid Hormone; D012709:Serum Albumin; D014284:Triiodothyronine; D014807:Vitamin D; C097949:1,25-dihydroxyvitamin D; D010074:Oxandrolone; D013972:Thyrotropin; D013006:Growth Hormone; C104450:25-hydroxyvitamin D; D013974:Thyroxine; D006854:Hydrocortisone