Treatment for Vitamin D Level of 14
For a vitamin D level of 14 ng/mL, treatment should include vitamin D supplementation with 50,000 IU weekly for 8 weeks, followed by maintenance therapy of 1,000-2,000 IU daily or 50,000 IU monthly to achieve and maintain serum 25(OH)D levels above 30 ng/mL. 1
Understanding Vitamin D Deficiency
A vitamin D level of 14 ng/mL indicates significant deficiency, as it falls well below the generally accepted threshold of:
- Deficiency: <20 ng/mL
- Insufficiency: 20-30 ng/mL
- Optimal: >30 ng/mL
This deficiency can lead to several health consequences:
- Secondary hyperparathyroidism
- Increased bone turnover and bone loss
- Elevated fracture risk
- Neuromuscular dysfunction
- Increased fall risk 2, 3
Treatment Protocol
Initial Loading Dose
- Administer ergocalciferol (vitamin D2) or cholecalciferol (vitamin D3) 50,000 IU weekly for 8 weeks 1
- This loading dose is necessary to rapidly correct the deficiency and replenish vitamin D stores
Maintenance Therapy
After the 8-week loading period:
- Continue with 1,000-2,000 IU daily OR
- 50,000 IU monthly 1
Monitoring
- Measure serum calcium, phosphorus, and 25-hydroxyvitamin D levels after at least 3 months of supplementation 1
- The goal is to achieve and maintain serum 25(OH)D levels above 30 ng/mL (75 nmol/L) 1, 4
Additional Considerations
Calcium Supplementation
- Ensure adequate calcium intake of 1,000-1,200 mg daily through diet or supplements 5
- This is essential for optimal bone health and to prevent secondary hyperparathyroidism
Lifestyle Modifications
- Increase dietary sources of vitamin D (oily fish, egg yolks, fortified foods) 1
- Consider safe sun exposure (though this alone is typically insufficient) 1
- For patients at risk of osteoporosis, include regular weight-bearing exercise 5
Special Population Considerations
If the patient is also:
- Over 65 years old
- Has limited sun exposure
- Has darker skin
- Is institutionalized
They may require ongoing supplementation at the higher end of the maintenance dose range (2,000 IU daily) 1
Safety Considerations
- Vitamin D supplementation at recommended doses is generally safe
- The upper safe limit for most adults is 4,000 IU daily 1
- Toxicity is rare but can occur with prolonged high doses (>10,000 IU daily) 1
- Signs of toxicity include hypercalcemia, hypercalciuria, and nephrocalcinosis 1
Pitfalls to Avoid
Inadequate loading dose: A cumulative dose of at least 600,000 IU administered over several weeks appears necessary to replenish vitamin D stores in documented deficiency 6
Single large doses: Avoid single large doses of 300,000-500,000 IU as they may be less effective and potentially harmful 6
Failure to monitor: Not checking follow-up vitamin D levels may lead to persistent deficiency or potential toxicity
Ignoring calcium intake: Vitamin D supplementation is most effective when combined with adequate calcium intake 5
Overlooking adherence: Monthly dosing may improve adherence for patients who struggle with daily supplementation 4