25 HYDROXY-VITAMIN-D LEVEL INVESTIGATION AND MANAGEMENT

CLINICAL AUDIT IN A TERTIARY HOSPITAL IN CENTRAL PAHANG, MALAYSIA

Abstract

INTRODUCTION/BACKGROUND
The prevalence of vitamin D deficiency in Malaysia in different populations has been quoted to be between 20 to 90%. Adequate vitamin D in food sources, sun exposure, or supplementation are preventative measures for vitamin D deficiency. Vitamin D level screening is limited by resources in government hospitals and targeted screening in highrisk patients are performed. This study was conducted to ascertain the practice of 25-hydroxyvitamin D screening and management of vitamin D deficiency.

METHODOLOGY
All patients with 25-hydroxyvitaminD levels done at the Hospital Sultan Haji Ahmad Shah, Temerloh in 2023 were included. Patient demographic data, clinical profile, 25-hydroxyvitamin D and vitamin D deficiency management were assessed through electronic medical records.

RESULTS
A total of 126 samples of 25-hydroxyvitamin D were done in 2023 for 100 patients. Majority were paediatric patients (65%) and the rest were adult patients (35%). Mean 25-hydroxyvitamin D levels for adult and paediatric patients were 44.5 nmol/L and 99.8 nmol/L respectively. Most of the investigations were for screening of 25-hydroxyvitamin D status (68.6%) while 21.4% were for monitoring of 25-hydroxyvitamin D levels for patients who are already undergoing vitamin D treatment. Common indications for 25-hydroxyvitamin D in paediatric patients included renal disease (24.6%), prematurity (16.9%), hypocalcaemia (9.2%) and high ALP (7.6%). In adult patients, common indications included renal disease (20%), hypocalcaemia (11.4%), hypercalcemia (7.6%) and osteoporosis (7.6%). Vitamin D deficiency was present in 43.1% (n = 28) of paediatric patients and 54.3% (n = 19) of adult patients. Among paediatric patients with vitamin D deficiency, 67.9% (n = 19) were treated with inactivated vitamin D while 25% (n = 7) did not receive any treatment. Among adult patients with vitamin D deficiency, 15.7% (n = 3) were treated with inactivated vitamin D and 42.1% (n = 8) did not receive any treatment.

CONCLUSION
There was a huge discrepancy in the number of 25-hydroxyvitamin D samples sent in adult and paediatric patients, which may indicate lower awareness of vitamin D screening among adult patients. The high proportion of adult patients with vitamin D deficiency who are not optimally managed with vitamin D supplementation reflect the need to standardize and monitor vitamin D treatment in the hospital.