Çocuk Yoğun Bakım Ünitesindeki Hastaların D Vitamini Seviyeleri

Amaç: Çocuk Yoğun Bakım Ünitesinde (ÇYBÜ) yatan hastalarda serum 25-hidroksivitamin D (25-OHVitD) düzeyleri tespit edilerek D vitamini eksikliği saptananlara D vitamini desteği verilmesi; ayrıca ÇYBÜ’deki kronik hastalığı üstüne akut hastalık eklenen hastalarla sadece akut hastalığı olanların D vitamini seviyelerinin karşılaştırılması amaçlandı.Gereç ve Yöntem: Çalışmaya Ocak 2015- Haziran 2016 tarihleri arasında İnönü Üniversitesi Turgut Özal Tıp Merkezi ÇYBÜ’ye yatırılan 1 ay-18 yaş aralığındaki 327 hasta (A grubu) ve kontrol grubu olarak sağlıklı 90 vaka (B grubu) alındı. A grubu, sadece akut hastalığı olan (A1 grubu=125 hasta) ve kronik hastalığı üzerine akut hastalık eklenen (A2 grubu=202 hasta) hastalar olmak üzere ikiye ayrıldı. Tüm vakaların demografik bilgileri, 25-OHVitD, Ca, P ve ALP düzeyleri retrospektif taranarak kaydedildi.Bulgular: 25-OHVitD seviye ortalamaları sırasıyla A grubunda 20,9±16,4 ng/dl; A1 grubunda 25,7±17,2 ng/dl; A2 grubunda 17,9±15,2 ng/dl; B grubunda 25,9±14,4 ng/dl bulundu. D vitamini eksikliği sırasıyla A grubunda %55, A1 grubunda %43,2, A2 grubunda %62,4, B grubunda %40; yetersizliği A grubunda %16, A1 grubunda %17,6, A2 grubunda %14,9, B grubunda %20; yeterliliği A grubunda %29, A1 grubunda %39,2, A2 grubunda %22,8, B grubunda %40 bulundu. Yaşın artışı ve kronik hastalık varlığı D vitamini düzeyi üzerinde belirleyici faktörlerdi.Sonuç: Hastaların yaşı arttıkça D vitamini eksikliği görülme sıklığının arttığı görüldü. ÇYBÜ’deki hastalarda ve özellikle de kronik hastalığı olanlarda D vitamini eksikliğinin daha sık görüldüğü tespit edildi. ÇYBÜ’de yatan ve ek olarak kronik hastalığı olan çocuklarda D vitamini eksikliğinin giderilmesinin tedavilerine katkıda bulunabileceği sonucuna varıldı.

Anahtar Kelimeler:

D vitamini, çocuk yoğun bakım, kronik hastalıklar

Vitamin D Levels of Pediatric Intensive Care Patients

Objective: By measuring serum 25-hydroxyvitamin D (25-OHVitD) levels of the patients in Pediatric Intensive Care Unit (PICU), vitamin D supplementation is aimed to those who have been determined to have vitamin D deficiency. Furthermore, it is aimed to compare the vitamin D levels of only acute disease patients with acute disease added to the chronic disease in PICU.Methods: 327 patients (Group A) aged in the range of 1 month to 18 years, that have been hospitalized in PICU of İnönü University TurgutÖzal Medicine Centre from January 2015 to June 2016, and 90 healthy subjects as a control group (Group B) were included. Group A was divided into two; patients with only acute disease (A1=125 patients) and patients with acute disease added to the chronic disease (A2=202 patients). Demographic information and 25-OHVitD, Ca, P, ALP levels of all cases were recorded retrospectively.Results: Mean of the 25-OHVitD level was 20.9±16.4 ng/dl in Group A; 25.7±17.2 ng/dl in Group A1;17.9±15.2 ng/dl in Group A2 and 25.9±14.4 ng/dl in Group B, respectively. Vitamin D deficiency was 55% in Group A, 43.2% in Group A1, 62.4% in Group A2 and 40% in Group B. In addition, vitamin D insufficiency was 16% in Group A, 17.6% in Group A1, 14.9% in Group A2 and 20% in Group B. On the other hand, vitamin D sufficiency was 29% in Group A, 39.2% in Group A1, 22.8% in Group A2, and 40% in Group B. The increase of age and presence of chronic illness were the determining factors of vitamin D level.Conclusion: It has been found that, the incidence of vitamin D deficiency increases in prevalence, as age increases. The patients in PICU, especially those who have chronic illness, were found to have vitamin D deficiency more frequent. It is concluded that elimination of vitamin D deficiency may contribute to the treatment of the disease for the patients in PICU and the children with chronic illness.

Keywords:

Vitamin D, pediatric intensive care, Chronic Disease,

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1. Yurdakök M. Doğa ve insan tarihinde vitamin D. Katkı Pediatri Dergisi 1990; 11:345–386. 2. Yurdakök M. Pediatrik Paleopatoloji Kemikler Mumyalar ve Çocuklar. Ankara: Öztürk Matbaası, 1986:1-86. 3. Lee DM, Rutter MK, O'Ne ill TW, et al. European Male Ageing Study Group. Vitamin D, parathyroid hormone and the metabolic syndrome in middle-aged and older European men. Eur J Endocrinol 2009;161(6):947-954. 4. Humble MB. Vitamin D, light and mental health. J Photochem Photobiol B 2010;101(2):142-149. 5. Nimitphong H, Holick MF. Vitamin D, neurocognitive functioning and immunocompetence. Curr Opin Clin Nutr Metab Care 2011;14(1):7-14. 6. Cranney A, Horsley T, O'Donnell S, et al. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess (Full Rep) 2007;(158):1-235. 7. Dobnig H, Pilz S, Scharnagl H, et al. Independent association of low serum 25-hydroxy vitamin d and1,25-dihydroxy vitamin d levels with all-cause and cardiovascular mortality. Arch In tern Med 2008;168(12):1340-1349. 8. Rippel C, South M, Butt WW, et al. Vitamin D status in critically ill children. Intensive Care Med 2012 Dec; 38(12): 2055-2062. 9. Misra M, Pacaud D, Petryk A, et al; Drug and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society: Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics 2008;122, 398-417,. 10. Gordon CM, DePeter KC, Feldman HA, et al. Prevalence of vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med. 2004;158, 531-537. 11. Rippel C, South M, Butt WW, et al. Vitamin D status in critically ill children. Intensive Care Med (2012); 38:2055–2062. 12. Singhi SC, Singh J, Prasad R. Hypocalcaemia in a paediatric intensive care unit. J Trop Pediatr 2003;49: 298-302. 13. Lee P, Eisman JA, Center JR: Vitamin D deficiency in critically ill patients. N Engl J Med, 2009a: 360, 1912-1914. 14. Desai TK, Carlson RW, Geheb MA: Parathyroid-vitamin D axis in critically ill patients with unexplained hypocalcemia. Kidney Int Suppl 1987;22: 225-228. 15. Maiya S, Allgrove J, Mok Q. Vitamin D deficiency and mortality and serious morbidity in infancy: time for action. Arch Dis Child 2006;91, A71. 16. Kumar J, Muntner P, Kaskel FJ, Hailpern SM, Melamed ML: Prevalence and associations of 25-hydroxyvitamin D deficiency in U.S. children: NHANES 2001-2004. Pediatrics 2009;124, e362-e370. 17. McNally JD, Menon K, Chakraborty P, et al. Canadian Critical Care Trials Group: The association of vitamin D status with pediatric critical illness. Pediatrics 2012;130:429-436. 18. Madden K, Feldman HA, Smith EM, et al. Vitamin D deficiency in critically ill children. Pediatrics 2012;130:421-428. 19. Lee P. Vitamin D metabolism and deficiency in critical illness. Best Pract Res Clin Endocrinol Metab 2011 Oct; 25(5): 769-781. 20. Rey C, Sánchez-Arango D, López-Herce J, et al. Vitamin D deficiency at pediatric intensive care admission. J Pediatr (Rio J) 2014 Mar-Apr; 90(2): 135-142. 21. Çiğdem H. Kritik hasta çocuklarda d vitamini eksikliğinin sikliği ve prognozla ilişkisi uzmanlık tezi. Samsun Ondokuz Mayıs üniversitesi 01.2016. 22. Güneş N. Yoğun bakim hastalarinda D vitamini düzeyi takibi uzmanlık tezi. İÜ Cerrahpaşa tıp fakültesi. 2014 23. Holick MF. Vitamin D deficiency. N Engl J Med 2007;357, 266-281. 24. Ayulo M Jr, Katyal C, Agarwal C et al. The prevalence of vitamin D deficiency and its relationship with disease severity in an urban pediatric critical care unit. Endocr Regul. 2014;48:69–76. 25. Hebbar KB, Wittkamp M, Alvarez JA et al. Vitamin D Deficiency in Pediatric Critical Illness. J Clin Transl Endocrinol. 2014;1:170–175. 26. Özkan B, Yıldırım ZK. Rikets. Güncel Çocuk Sağlığı. 2007;5:34-41. 27. Wagner CL, Taylor SN, Hollis BW. Does Vitamin D make the world go round? Breastfeeding Medicine 2008; 3: 239-250. 28. Lucidarme O, Messai E, Mazzoni T, et al. Incidence and risk factors of vitamin D deficiency in critically ill patients: results from a prospective observational study. Intensive Care Med 2010 Sep; 36(9): 1609-1611. 29. Ponnarmeni S, Angurana SK, Singhi S et al. Vitamin D deficiency in critically ill children with sepsis. Paediatrics and International Child Health. 2015;10:1-7. 30. Aygencel G, Turkoglu M, Tuncel AF et al. Is vitamin d insufficiency associated with mortality of critically ill patients? Crit Care Res Pract 2013; 2013: 856747. 31. Matthews LR, Ahmed Y, Wilson KL, et al. Worsening severity of vitamin D deficiency is associated with increased length of stay, surgical intensive care unit cost, and mortality rate in surgical intensive care unit patients. Am J Surg 2012 Jul; 204(1): 37-43. 32. Zittermann A, Gummert JF, Börgermann J. Vitamin D deficiency and mortality. Curr Opin Clin Nutr Metab Care 2009 Nov; 12(6): 634-639. 33. Melamed ML, Michos ED, Post W et al. 25-hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med 2008 Aug 11; 168(15): 1629-1637.

ISSN: 1309-3878
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 2009
Yayıncı: Düzce Üniversitesi Tıp Fakültesi Aile Hekimliği AD adına Yrd.Doç.Dr.Cemil Işık Sönmez