What is the treatment for a Vitamin D level of 12?

Treatment for Vitamin D Level of 12 ng/mL

For a vitamin D level of 12 ng/mL (severe deficiency), treatment should consist of ergocalciferol (vitamin D2) 50,000 IU weekly for 8 weeks, followed by maintenance therapy of 800-2000 IU daily to achieve optimal 25(OH)D levels above 30 ng/mL. 1

Initial Treatment Phase

A vitamin D level of 12 ng/mL falls well below the deficiency threshold of <20 ng/mL and requires prompt correction:

• Initial correction regimen:
  • Ergocalciferol (vitamin D2) 50,000 IU weekly for 8 weeks 1, 2
  • OR Cholecalciferol (vitamin D3) at equivalent doses 1
  • For patients with obesity or malabsorption syndromes, higher doses may be required:
    • Consider 50,000 IU weekly or 30,000 IU twice weekly for 6-8 weeks 1, 3

Maintenance Phase

After the initial correction phase:

• Maintenance therapy:
  • Daily vitamin D3 (cholecalciferol) 800-2000 IU 1, 2
  • For patients with obesity or malabsorption, higher maintenance doses of up to 7000 IU daily may be necessary 3

Calcium Supplementation

• Ensure adequate calcium intake:
  • 1000 mg daily for adults under 50 years 1
  • 1200 mg daily for adults over 50 years 1
  • Take calcium supplements in divided doses of no more than 600 mg at once 1
  • Adequate dietary calcium is necessary for response to vitamin D therapy 4

Monitoring

• Check 25(OH)D levels after at least 3 months of supplementation 1
• Target serum 25(OH)D level should be at least 30-40 ng/mL for optimal health 1
• Monitor serum calcium in patients at risk for hypercalcemia 1

Special Considerations

• For obese patients:

  • May require 2-3 times the standard dose of vitamin D 1
  • Consider 7000 IU/day or 30,000 IU/week as maintenance therapy 3

• For patients with malabsorption:

  • Higher doses and more frequent monitoring are required 1
  • Consider 30,000 IU twice weekly or 50,000 IU weekly for initial treatment 3

• For patients with kidney disease:

  • Require careful monitoring and dose adjustment based on GFR 1
  • Avoid calcitriol or other 1-hydroxylated vitamin D sterols for treating deficiency 1

Managing Side Effects

• Take vitamin D supplements with food to reduce gastrointestinal symptoms 1
• Consider splitting the dose if available 1
• For significant GI symptoms:
  • Consider reducing frequency to 50,000 IU every 2 weeks or monthly 1
  • Ondansetron 4-8 mg or metoclopramide 10 mg 30-60 minutes before ergocalciferol can help manage nausea 1

Cautions

• Vitamin D toxicity is rare but can occur with daily doses >50,000 IU that produce 25(OH)D levels >150 ng/mL 1
• Avoid single mega-doses of 300,000-500,000 IU as they may be less effective and could potentially cause adverse effects 5
• Avoid taking calcium supplements with ergocalciferol as this may worsen GI symptoms 1