Vit D - A very urgent case
Nayyer
or even more. Five nights ago I undersand it and I stopped it. What
should I do now? Am I losing Calcium now? What will happen to me? What
should I do?
John 'the Man'
Once upon a time, our fellow Nayyer
rambled on about "Vit D - A very urgent case."
Our champion being bored in sci.med.nutrition retorts, thusly ...
You could start by stating how much you took of it on a daily basis.
Baron Blackfang
"Nayyer" <nay...@hotmail.com> wrote in message
news:e0d6064c.02030...@posting.google.com...
If you just took 400 IU of Vitamin D and consumed at least the RDA of
Calcium, I doubt if you did any harm. A month isn't long enough to
accumulate a large amount of vitamin D unless you megadosed on it.
Matti Narkia
<nQXh8.2320$Nd.1...@newsread2.prod.itd.earthlink.net> "Baron
winter and no oral vitamin D is taken. For example in the trial
Gloth FM 3rd, Alam W, Hollis B.
Vitamin D vs broad spectrum phototherapy in the treatment of seasonal
affective disorder.
J Nutr Health Aging. 1999;3(1):5-7.
PMID: 10888476 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10888476&dopt=Abstract
some subjects received a single shot of 100,000 I.U. of vitamin D.
-Matti Narkia
Martin Banschbach Ph.D.
Your liver stored the vitamin D. Even if you were taking 1,000 IU of D for a
month or two, it's not going to overload your liver. Don't worry about it.
Marty B "You are what you eat"
Nayyer
of doing such a mistake in my life.
I have used Vitamin D3 - 50.000 I.U. made by Merck , I really don't
know the quantity I have used, but it should be about 60 capsules in a
period of 3 months or less. They have been mixed with my Vit E
capsules and I didn't know about it. I have used one capsule every
night, which has been either Vit E or Vit D.
I will meet a docotor this afternoon, I want to know how it could harm
my livre. What should I eat? Can I continue my daily food and fruits?
Martin Banschbach
The easiest way to find out what kind of load you have is to ask for a
serum
25-hydroxy-vitamin D test. This test will tell if you have put too
much vitamin D in your liver.
JEDilworth
abnormal, you could go with the expensive test next. Nayyer might not
have medical insurance, and I'll bet that test would set him back quite
a few bucks. Liver enzymes are run on a multi-times a day basis in labs
everywhere. The test you're talking about is probably only run a few
places in the US.
I KNOW you like these fancy lab tests, Martin, but there really are
easier ways to tell if he has liver damage :-).
Judy Dilworth, M.T. (ASCP)
Microbiology
Steve Harris
And how will it tell you that? And why should you care? Test your serum
calcium (with an ionized calcium if you must) and see if you're over the
normal limit. If it's okay, you got away with the vitamin D overdose, and
(so long as you don't take any more) you can forget about it.
SBH
--
I welcome email from any being clever enough to fix my address. It's open
book. A prize to the first spambot that passes my Turing test.
Martin Banschbach PhD
Serum 25-hydroxy vitamin D is the gold standard for determining vitamin D
toxicity as is serum retinol for vitamin A toxicity. Look it up Steve.
Test your serum
> calcium (with an ionized calcium if you must) and see if you're over the
> normal limit. If it's okay, you got away with the vitamin D overdose, and
> (so long as you don't take any more) you can forget about it.
Steve, you know that ionized calcium can be affected by a very large number
of factors. I had mentioned that only 1 book has been written for medical
student education in the area of nutrition (IMHO). It's Fundamentals of
Clinical Nutrition by Weinsier and Morgan.
A plasma 25-OH-D3 more than 400 ng/ml indicates vitamin D toxicity with or
without a change in ionized calcium Steve. The only other condition that
can give an elevation of this marker is kidney failure (according to these
two M.D.'s).
Sarah Morgan, M.D., R.D., FACP and Roland Weinsier, M.D., Dr.PH, FACP are
both well known as physician-nutritionists. If you don't have their book, I
suggest that you get it.
--
Marty B. "You are what you eat."
http://centernet.okstate.edu/nutrition/index.html
The above website is for educational purposes
only. Material in this website and posted material
represents the opinion of Martin Banschbach,
Ph.D. and does not reflect Oklahoma State
University policy or position on nutrition.
Issues regarding the diagnosis and treatment
of human disease can not be addressed
by material in the above website or by
Martin Banschbach, Ph.D.
Any comments made by Martin
Banschbach, Ph.D. are invalid unless
confirmed by your personal physician.
Nayyer
in the normal range. Does this mean that everything is ok with me
now?
Steve Harris
> I did a blood test. The Calcium and Phosphur content of my blood is
> in the normal range. Does this mean that everything is ok with me
> now
Almost certainly. If vit D overdose hasn't raised your calcium by now, it
won't. And that's really the worst it could do.
SBH
--
I welcome Email from strangers with the minimal cleverness to fix my address
(it's an open-book test). I strongly recommend recipients of unsolicited
bulk Email ad spam use "http://combat.uxn.com" to get the true corporate
name of the last ISP address on the viewsource header, then forward message
& headers to "abuse@[offendingISP]."
?
Martin Banschbach Ph.D.
>I did a blood test. The Calcium and Phosphur content of my blood is
>in the normal range. Does this mean that everything is ok with me
>now?
Vitamin D toxicity involves release of calcium from bone and increased
absorption of dietary calcium with the chance that hypercalcemia can occur.
This higher than normal calcium level in blood can lead to calcification of
soft tissues.
Calcium is regulated much better than many of the other minerals that are found
in human blood. It's only the ionized (free) calcium that moves and can lead
to calcification of soft tissues and this is what Steve suggested as a
measurement to determine if you had too much vitamin D stored in your liver.
Ionized calcium levels can change without a movement of total calcium into a
higher than normal range but this is unlikley with vitamin D toxicity.
A serum calcium is a "snapshot". It can be used to confirm vitamin D toxicity
but it can't be used to rule it out. I will tell you though that if your liver
really does have way too much vitamin D stored, the 25-hydroxy D levels in
blood will probably be high enough to push the total calcium into a higher than
normal range.
I would not worry about getting any more tests run. Don't use any supplements
that contain vitamin D. Using a magnesium supplement may help if you do have a
slight elevation in ionized calcium.
High dose A and D are both used to load the liver in people who are having
trouble storing vitamin A or vitamin D. This is usually done in developing
countries where health teams can not get at these people on a regular basis.
You have basically loaded your liver with vitamin D.
A normal total calcium indicates that the 25-hydroxy D levels are probably not
high enough to cause a significant movement of calcium out of bone.
The only way to determine exactly how much vitmain D is stored in your liver is
through a 25-hydroxy D lab test. I don't recall what the cost is. It's not a
routine clinical lab test.
If you still have some nagging doubts about what using a high dose vitamin D
supplement may have done to you, you could check to see if your insurance would
cover the cost of the lab test.
If your total serum calcium had been high, it probably would have been ordered
and your insurance probably would have paid for it. If you don't have health
insurance and you don't have any extra money floating around, I would not worry
about trying to get it done.
Extra iron and extra vitamin D may both play a role in the development of some
human diseases so I've had storage for both checked in myself and both have
been covered by my insurance.
Homocysteine is a much bigger threat than iron or vitamin D are and I still
need to get that checked. Some insurance companies will pay for preventative
lab tests and others will not. Mine has been pretty good but with the plan
renewal on Jan 1st I got a letter that my statin drug would no longer be
covered. They are now insisting on generic for statin therapy. I've already
had to have my doctor write a new prescription in the past to switch me from
Lipitor to Provachol because they stopped paying for Lipitor prescriptions.
Now they will not pay for Provachol prescriptions. They used to cover Cox-2
inhibitors, now they don't so I get my refills and pay for them myself.
My son's insurance used to cover anti-psychotics, now they don't so I also have
to pay for his medication myself.
Cutting costs on the front end does not make much sense to me because the long
term costs go up.
You got a lot of different kinds of advice on what to do with your problem
(took a high dose D by mistake).
I don't think that you have to worry about it anymore.
Steve Harris
news:20020313102612...@mb-ch.aol.com...
> A serum calcium is a "snapshot". It can be used to confirm vitamin D
toxicity
> but it can't be used to rule it out.
And why not? If your calcium level is normal NOW, you can't have vitamin D
toxicity NOW. The worst you can have is calcification from it in the PAST,
or enough unabsorbed vit D in your stomach (if you just swallowed a bottle)
to give you problems later, but that's unlikely here.
> A normal total calcium indicates that the 25-hydroxy D levels are probably
not
> high enough to cause a significant movement of calcium out of bone.
I don't believe that high 25-hydroxyD causes *much* calcium to move out of
bone. A little goes in that direction, but certainly not enough to cause
condromalacia per se (as low vit D does). The high serum calcium and tissue
calcification in vit D in poisoning is generally caused by overabsorption.
The calcium for it mostly does not come from the bones.
> The only way to determine exactly how much vitmain D is stored in your
liver is
> through a 25-hydroxy D lab test. I don't recall what the cost is. It's
not a
> routine clinical lab test.
Actually it is commonly done on non-milk drinking non-supplement using women
in workups for osteoporosis, in higher latitudes (anything where you get
snow in winter) where sunlight is scarce. I've ordered many a 25-hydrox D
test.
By the way, here's a fascinating article suggesting that the presently
recognized upper safe vitamin D limit of 2,000 IU (5 standard OTC pills) a
day is probably low by a factor of at least 5, since people working in
sunlight get 10,000 a day, and all known tox cases have been at more than
40,000 IU a day (and that for a long time). So our poster doesn't have that
much to worry about
============================================
Am J Clin Nutr 1999 May;69(5):842-56
Comment in:
Am J Clin Nutr. 1999 May;69(5):825-6.
Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety.
Vieth R.
Department of Laboratory Medicine and Pathobiology, University of Toronto,
Mount Sinai Hospital, Ontario, Canada. rvi...@mtsinai.on.ca
For adults, the 5-microg (200 IU) vitamin D recommended dietary allowance
may prevent osteomalacia in the absence of sunlight, but more is needed to
help prevent osteoporosis and secondary hyperparathyroidism. Other benefits
of vitamin D supplementation are implicated epidemiologically: prevention of
some cancers, osteoarthritis progression, multiple sclerosis, and
hypertension. Total-body sun exposure easily provides the equivalent of 250
microg (10000 IU) vitamin D/d, suggesting that this is a physiologic limit.
Sailors in US submarines are deprived of environmentally acquired vitamin D
equivalent to 20-50 microg (800-2000 IU)/d. The assembled data from many
vitamin D supplementation studies reveal a curve for vitamin D dose versus
serum 25-hydroxyvitamin D [25(OH)D] response that is surprisingly flat up to
250 microg (10000 IU) vitamin D/d. To ensure that serum 25(OH)D
concentrations exceed 100 nmol/L, a total vitamin D supply of 100 microg
(4000 IU)/d is required. Except in those with conditions causing
hypersensitivity, there is no evidence of adverse effects with serum 25(OH)D
concentrations <140 nmol/L, which require a total vitamin D supply of 250
microg (10000 IU)/d to attain. Published cases of vitamin D toxicity with
hypercalcemia, for which the 25(OH)D concentration and vitamin D dose are
known, all involve intake of > or = 1000 microg (40000 IU)/d. Because
vitamin D is potentially toxic, intake of >25 microg (1000 IU)/d has been
avoided even though the weight of evidence shows that the currently
accepted, no observed adverse effect limit of 50 microg (2000 IU)/d is too
low by at least 5-fold.
Matti Narkia
<a6quh8$n9i$1...@slb7.atl.mindspring.net> "Steve Harris"
<sbha...@ix.RETICULATEDOBJECTcom.com> wrote:
>By the way, here's a fascinating article suggesting that the presently
>recognized upper safe vitamin D limit of 2,000 IU (5 standard OTC pills) a
>day is probably low by a factor of at least 5, since people working in
>sunlight get 10,000 a day, and all known tox cases have been at more than
>40,000 IU a day (and that for a long time). So our poster doesn't have that
>much to worry about
>
>============================================
>
>Am J Clin Nutr 1999 May;69(5):842-56
>Comment in:
>Am J Clin Nutr. 1999 May;69(5):825-6.
>
>Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety.
>
>Vieth R.
>
>Department of Laboratory Medicine and Pathobiology, University of Toronto,
>Mount Sinai Hospital, Ontario, Canada. rvi...@mtsinai.on.ca
>
There were a few vitamin D related threads here about two months ago,
starting in the end of December and continuing at least until
mid-January. Reinhold Vieth also participated with a couple of messages.
BTW, the full text of above article is freely available, urls are
http://www.ajcn.org/cgi/content/full/69/5/842
http://www.ajcn.org/cgi/reprint/69/5/842.pdf
Other related texts:
Robert P Heaney
Lessons for nutritional science from vitamin D
American Journal of Clinical Nutrition,
Vol. 69, No. 5, 825-826, May 1999
http://www.ajcn.org/cgi/content/full/69/5/825 (free)
Vieth, R., Chan, P.C. R, MacFarlane, G. D
Efficacy and safety of vitamin D3 intake exceeding the lowest observed
adverse effect level.
Am J Clin Nutr 2001 Feb;73(2):288-94
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=11157326&dopt=Abstract
http://www.ajcn.org/cgi/content/abstract/73/2/288
http://www.ajcn.org/cgi/content/full/73/2/288
http://www.ajcn.org/cgi/reprint/73/2/288.pdf
The Merck Manual's chapter
THE MERCK MANUAL, Sec. 1, Ch. 3, Vitamin Deficiency, Dependency,
And Toxicity.
Vitamin D Toxicity
http://www.merck.com/pubs/mmanual/section1/chapter3/3e.htm
starts as follows:
"Vitamin D 1000 痢 (40,000 IU)/day produces toxicity within 1 to 4
mo in infants, and as little as 75 痢 (3000 IU)/day can produce
toxicity over years. Toxic effects have occurred in adults
receiving 2500 痢 (100,000 IU)/day for several months. Elevated
serum calcium levels of 12 to 16 mg/dL (3 to 4 mmol/L) are a
constant finding when toxic symptoms occur; normal levels are 8.5
to 10.5 mg/dL (2.12 to 2.62 mmol/L). Serum calcium should be
measured frequently (weekly at first, then monthly) in all
patients receiving large doses of vitamin D.
The first symptoms are anorexia, nausea, and vomiting, followed by
polyuria, polydipsia, weakness, nervousness, and pruritus. Renal
function is impaired, as evidenced by low sp gr urine,
proteinuria, casts, and azotemia. Metastatic calcifications may
occur, particularly in the kidneys. Plasma 25(OH)D3 levels are
elevated as much as fifteenfold in vitamin D toxicity, whereas
1,25(OH)2D3 levels are usually within the normal range."
-Matti Narkia
Steve Harris
news:vb429uc9ellrg0dkj...@4ax.com...
> The Merck Manual's chapter
>
> THE MERCK MANUAL, Sec. 1, Ch. 3, Vitamin Deficiency, Dependency,
> And Toxicity.
> Vitamin D Toxicity
> http://www.merck.com/pubs/mmanual/section1/chapter3/3e.htm
>
> starts as follows:
> Elevated
> serum calcium levels of 12 to 16 mg/dL (3 to 4 mmol/L) are a
> constant finding when toxic symptoms occur; normal levels are 8.5
> to 10.5 mg/dL (2.12 to 2.62 mmol/L).
Thank you. Which is what I said.
Reinhold Vieth
YOU ASKED about vitamin D toxicity, because you
> have used Vitamin D3 - 50.000 I.U. made by Merck , about 60 capsules in a
> period of 3 months or less.
I am a clinical researcher specializing in vitamin D nutrition.
I am regularly asked similar panick questions about vitamin D, and
have read with interest the many previous recommendations offered you
since you posted your request for advice.
NUMBER ONE: what any responsible physician MUST do for a patient
presenting as you did, MEASURE THE 25(OH)D LEVEL !!!! If the level is
less than 300 nmol/L (for Americans, that works out to < 120 ng/mL)
you can rest assured there is nothing toxic going on. There have been
lots of people getting your kind of dose for therapeutic purposes, and
without problem. At a guess, from what you say, if you were taking
vit D3 (which I doubt, since 50000 formulations in the US have to my
knowledge been vit D2 - not D3), then I would predict your 25D
concentration would be close to 300 nmol/L. If higher, than this, and
your serum and urine calcium levels are normal, then again, you have
no problem. If you still find out you have a toxicity problem, then
your Dr should discuss treatment with a corticosteroid and/or
bisphosphonate with you.
In Canada, there is no problem in getting a 25D level done by any
physician if toxicity is a concern. I am surprised you have not
reported to this discussion group what your 25D result is.
If you really want to see what vitamin D toxicity is like, check the
Feb 23, 2002 issue of the Lancet, in which two people each consumed
over 1 million IU of vit D3, daily, for SEVEN MONTHS! From what you
say, you would have only taken a grand total of 1.5 million units -
what these patients took in just one day. The patients we reported in
the Lancet showed all the classic signs: hypercalcemia,
hypercalciuria, kidney calcium deposits, dehydration, nausea,
vomiting, weight loss. The symptoms are long term, if not treated.
When the patient first presented at the emergency room, the symptoms
were thought to be gastroenteritis (part of the initial differential
diagnosis). You evidently don't show any of those symptoms.
Vitamin D continues to be the boogey-man of nutrition. I would not
recommend taking 50000 IU per day without a reason, but a few days of
it should not be a problem for a healthy adult. I note one person
responding here to your query stated that liver enzymes would be
affected by high vitamin D levels - there is NO WAY that happens! (If
anyone knows of peer-reviewed evidence contradicting my bold
statement, please let me know, because from what I have been able to
find, such liver notions are groundless).
Three questions for you:
1. Where did you get the 50000 IU capsules, because this dose is only
available by prescription?
2. Are you sure it was vit D3 that you took? To my knowledge all the
50000 IU doses available in North America are actually vit D2, which
probably has a different toxicity profile. i.e. Was it D2 or D3 ?
3. Would you please let us know your 25D level when you find out what
it is?
I would appreciate clarification on these 3 points.
Best wishes, and I assume you are doing well,
Reinhold Vieth
JEDilworth
times, I am not a chemistry technologist. I enjoy learning about case
histories, and the one you have presented is very interesting. I was
looking at this in a very simplistic mode and obviously got it all
wrong. My apologies. I was looking at it totally from the viewpoint of
liver damage = elevated liver enzymes. Obviously it's much more
complicated than that.
Thanks for explaining all of this to a chemistry novice.
Judy Dilworth, M.T. (ASCP)
Microbiology
Steve Harris
news:3C9197AD...@nospamhortonsbay.com...
> Thanks for clearing up the liver enzyme question. As I have stated many
> times, I am not a chemistry technologist. I enjoy learning about case
> histories, and the one you have presented is very interesting. I was
> looking at this in a very simplistic mode and obviously got it all
> wrong. My apologies. I was looking at it totally from the viewpoint of
> liver damage = elevated liver enzymes. Obviously it's much more
> complicated than that.
It really is that simple, as liver damage always does cause elevation of
liver enzymes (while it's going on). The reason you don't see this with
vitamin D poisoning is simply that it doesn't cause liver damage! That's
vitamin A poisoning.
I'm glad to get Dr. Vieth's input on this as the recognized expert in the
field, but I still don't know why he's recommending testing 25-OH-D levels,
as I cannot see how they would change your treatment in the eucalcemic
patient. In the patient who has stopped vitamin D and who has normal calcium
levels, it seems unlikely to impossible that they'll rise in the future, so
it doesn't matter what his blood levels for D are-- you're never going to
see or test him again unless he becomes symptomatic (nauseus, anorexic,
polyuric, etc). If he does become symptomatic, then you'll have to test him
for calcium anyway, and there's no point in testing for D levels if the
calcium continues to be normal. Only if it's ABNORMAL do you have to go on
to test for D levels, as you then need to differentiate some latent weird D
toxicity from some new and unrelated medical problem, like parathyroidosis
or Ca hormone-active tumor. Otherwise, it appears to me you're wasting
money.
Steve
JEDilworth
liver discussion got inserted in the thread (can't remember if I did or
someone else; it's moot at this point) I made the assumption about Vit.
D.
I remember from training that elevated calcium can indicate thyroid
problems but didn't realize it was also connected to Vit. D. toxicity.
Medical insurance companies don't like to pay out for extremely
expensive testing unless a diagnosis code supports the test request. It
seems perfectly reasonable to me from the monetary standpoint to run the
Ca levels first and then go to the esoteric testing if the Ca screening
is abnormal. Again, I am not a physician so cannot comment on the
diagnostic side of ordering blood work. We do what the physician
orders. We do not decide, the physician does.
Thanks for again updating my knowledge base :-) on this topic.
Judy Dilworth, M.T. (ASCP)
Microbiology
Knows All'@hotmail.com John 'Knows All
> seems perfectly reasonable to me from the monetary standpoint to run the
> Ca levels first and then go to the esoteric testing if the Ca screening
> is abnormal. Again, I am not a physician so cannot comment on the
> diagnostic side of ordering blood work.
> Judy Dilworth, M.T. (ASCP)
> Microbiology
Here we see a MT practicing medicine without a license.
No one cares what a MT has to say about anything. The MT is the person
responsible for anonymously totally screwing up the results of important lab
work.
Judy, just because you work in a lab don't make you a MD. You are not even
a nurse. Just, another case of runaway ego, if your ask me. :-(
JEDilworth
monetary side of blood test ordering, not the diagnostic side. I said
flatly that I was not a physician in my post!
As far as your statement of "anonymously screwing up lab work," that is
an outright and blatant lie and you know it. I have been in this
business 28 years. I have yet to meet any of my fellow workers who
blatantly or anonymously purposely screwed up ANYONE's lab work, nor
have I. You'd better have proof of that statement before you continue
on this libelous thread.
Nurses are good at what they do, but many don't understand what labs
really do, as we techs don't know what nurses do. They are both very
important jobs, but totally different. Fully 70% of physician's
diagnoses are based on lab results, from what I've read in the past.
Today's physicians would be hard pressed to manage critically ill
patients without lab work to monitor them. I'm not necessarily talking
microbiology here; I'm talking about critical levels of hemoglobin,
electrolytes, liver function studies, blood gases. Medications and IV's
are adjusted according to results of these levels every day in every
hospital everywhere. Without lab results to guide them doctors would be
very much in the dark as to their patients' acid/base results, which can
change hourly.
Any doctors on the list, I'd appreciate a comment as to how you would
operate without lab results, especially for your critical patients, on a
day to day basis.
I have NEVER represented myself as a doctor. I've always identified
myself as a medical technologist.
You've just got a huge chip on your shoulder against anyone who knows
something you don't know.
If you attack me personally again, every response will be forwarded to
your ISP's abuse address. Your attacks have changed from the mere sting
to being mean, viscious, and personal, and I for one will not stand for
them any more.
Judy Dilworth, M.T. (ASCP)
Microbiology
Knows All'@hotmail.com John 'Knows All
> Apparently you cannot read, John. I said I was commenting on the
> monetary side of blood test ordering, not the diagnostic side. I said
> flatly that I was not a physician in my post!
I believe in ignoring DoubleSpeak. :-)
If you ain't a MD, kindly stop yacking about the monetary / diagnostic / or
any other side of health care.
People, who write I am not a physician and then practice medicine in the
same paragraph should be prosecuted.
Didn't they Learn YOU proper in MT school?
> As far as your statement of "anonymously screwing up lab work," that is
> an outright and blatant lie and you know it. I have been in this
> business 28 years. I have yet to meet any of my fellow workers who
> blatantly or anonymously purposely screwed up ANYONE's lab work, nor
> have I. You'd better have proof of that statement before you continue
> on this libelous thread.
That is what MT's do. They screw up the lab work and the patient ends up
dying because they receive the wrong treatment. It happens all the time,
dear. :-0
> Nurses are good at what they do, but many don't understand what labs
> really do, as we techs don't know what nurses do. They are both very
> important jobs, but totally different. Fully 70% of physician's
> diagnoses are based on lab results, from what I've read in the past.
> Today's physicians would be hard pressed to manage critically ill
> patients without lab work to monitor them. I'm not necessarily talking
> microbiology here; I'm talking about critical levels of hemoglobin,
> electrolytes, liver function studies, blood gases. Medications and IV's
> are adjusted according to results of these levels every day in every
> hospital everywhere. Without lab results to guide them doctors would be
> very much in the dark as to their patients' acid/base results, which can
> change hourly.
MTs are one step above Candy Strippers. :-)
> Any doctors on the list, I'd appreciate a comment as to how you would
> operate without lab results, especially for your critical patients, on a
> day to day basis.
>
> I have NEVER represented myself as a doctor. I've always identified
> myself as a medical technologist.
>
> You've just got a huge chip on your shoulder against anyone who knows
> something you don't know.
>
> If you attack me personally again, every response will be forwarded to
> your ISP's abuse address. Your attacks have changed from the mere sting
> to being mean, viscious, and personal, and I for one will not stand for
> them any more.
Kindly stop practicing Medicine without a License.
Kindly stop threating people, too.
Reinhold Vieth
Concerning your two postings above, parts of which are quoted here:
"John 'Knows All'" <John 'Knows All'@hotmail.com> wrote in message
> If you ain't a MD, kindly stop yacking about the monetary / diagnostic / or
> any other side of health care.
I disagree with you. I was very impressed with Judy Dilworth's
postings that you make fun of. She has been fair, candid, and I
respect her thoughtful critique of my own submission. All her comments
have welcome ones !!
There is nothing wrong with differences in opinion. However, the
approach you, John, have taken here has NOTHING to do with the issues
being discussed. What you have done with your postings is a major
reason why people do not like to take part in discussions like this.
You are doing harm, and YOU are the one who should be deprived of
the PRIVELEDGE of having a voice here. You have created a picture of
yourself that looks like a bored college kid who likes to see what
kind of a rise you can get out of others. POOR YOU.
Reinhold Vieth
Reinhold Vieth
> Medical insurance companies don't like to pay out for extremely
> expensive testing unless a diagnosis code supports the test request. It
> seems perfectly reasonable to me from the monetary standpoint to run the
> Ca levels first and then go to the esoteric testing if the Ca screening
> is abnormal.
I am not in the US, so I wonder, Is there not a "diagnostic code"
for a poisoning? It makes sense to me, that if there is a medical
query about an overdose or a poisoning, and if a diagnostic test for
that poison is available, then that test should be done.
The 25D level will certainly affect followup in this case:
1. if the patient thought he took vitamin D, but the 25D is low or
normal, then obviously the patient was wrong, and no more followup is
justified, and the patient can take calcium supplements
2. if the 25D is elevated, but without hypercalcemia, then there
should be a followup medical visit, to ensure the situation continues
to subside. If the 25D is elevated beyond 250-300 nmol/L (higher than
naturally possible for the human) then the patient should be advised
to keep away from calcium supplements for at least 6 months.
3. The final justification for doing the 25D test is that it contains
knowledge. There is very little record of what the 25D level will be
for given vitamin D intakes, and unless the suspected toxicology is
appropriately documented, then vitamin D will continue to be the
bogeyman of nutrition, just because we don't document the suspected
cases of toxicity properly. If this does not happen in the public
ongoing practice of medicine, then how can we learn about what happens
with high doses? I doubt that there is anybody out there willing to
take part in a toxicological clinical study of this, even if funded by
the NIH. I know that responsible manufacturers of vitamins keep very
close watch out for reports of cases of overdose. Occurrence and
effects of excessive intake are fundamental to public health.
You see, the 25D level does affect medical practice.
I am still waiting for a response from Nayyer to the 3 questions I
posed previously. Perhaps this case is not "very urgent" any more.
JEDilworth
Obviously one cannot memorize the whole thing.
Does anyone out there have access to one? These usually reside in
billing departments and medical offices and I do not have ready access.
I was also thinking in terms of speed - a Calcium can be done STAT
within an hour, whereas the 25D most assuredly is a sendout for most
laboratories. A STAT calcium can tell you whether you're in the
ballpark.
Thanks for bringing this up!
Judy Dilworth, M.T. (ASCP)
Microbiology
JEDilworth
Judy Dilworth, M.T. (ASCP)
Microbiology