How to treat vitamin D deficiency?
The goal serum 25 OH vitamin D level is 30 to 100 ng/mL. In general, 1000 units (IU) daily of vitamin D will raise the serum level by 6 to 10 ng/mL. I recommend the following:
|25 OH D Level||Management|
|20–30 ng/mL||2000 IU D3 daily|
|10–20 ng/mL||50,000 IU D2 weekly for 3 months, then 2000 IU D3 daily|
|<10 ng/mL||50,000 IU D2 twice weekly for 3 months, then 2000 IU D3 daily|
Patients with malabsorption syndromes, bowel bypass surgery, and severe liver disease, and those who take antiepileptic drugs may require higher doses. Some may need to be treated with calcitriol. Occult celiac disease should be considered in any Caucasian patient who fails to increase their vitamin D levels with appropriate supplementation. However, noncompliance is the most common reason that patients with persistently low vitamin D levels on therapy do not increase their levels.