Гипокальциурическая гиперкальциемия?

[Dr.Vad]

а какой протокол будете использовать? там и сроки повтора обозначены

in order to reach a serum level of 25 (OH) D above 30 ng/ml a minimum of 1000 IU or probably 1500-2000 IU/day is necessary.

There are two common protocols for the treatment of patients.

Holick protocol: Weekly Pearl 50000 IU of vitamin D3 for a period of 8 weeks given to the patient to replenish the deficient vitamin D. In the maintenance phase 50000 IU vitamin D3 is administered every 2 weeks. It is recommended to measure the serum level of 25 (OH D) after 2-3 months of treatment; and if the level is above 30 ng/ml the maintenance therapy should continue.[7]

The patient receives 500,000-1000,0000 IU of vitamin D3 in divided doses with oral pearl of 50,000 IU vitamin D3 in a period of 4-5 weeks (for instance the patient takes 1 pearl every 2-3 days). There is no any pearl given to the patient for the following 4-5 weeks. In this protocol after the end of the second 4-5 weeks the serum level of 25 (OH) D is measured and if it is above 30 ng/ml receives the maintenance therapy. The maintenance therapy composed of 50000 IU oral vitamin D3 on a monthly base. The level of serum PTH is measured during the treatment in order to make sure that the level of Parathyroid hormone has not increased from the base line value. In case of increase in serum PTH level during treatment the physician should suspect concurrent Primary Hyperparathyroidism which is not rare in case of vitamin D deficiency, since the vitamin D deficiency is epidemic.[12]

If the serum level of vitamin D during the 10-12 weeks of treatment does not increase to above 30 ng/ml, it is recommended to repeat the replacement protocol. However, if the level of serum vitamin D after 2 periods of treatment was low and the patient compliance to treatment is assured; the physician should suspect intestinal fat malabsorption as a differential diagnosis (for example celiac disease).