Introduction Vitamin D is required to maintain serum calcium levels within the normal range, maintain bone health and may have other beneficial effects. Patients on long term parenteral nutrition are at risk of vitamin D deficiency. A previous audit has shown levels were checked in 83% of patients on home parenteral nutrition (HPN) and this repeat audit aimed to discover whether patients are being monitored and treated in line with current NICE guidance.
Method All patients on HPN at the Freeman Hospital on 1 st January 2017 were included. Of those 5 were excluded: 3 died during the audit process and 2 were palliative. Electronic pathology and radiology databases were reviewed and data were collected about frequency of vitamin D level monitoring, provision of DEXA scanning, current medications and HPN regimes.
Results 82 of 101 patients had vitamin D levels measured in the preceding 6 months, increasing to 100 in the preceeding 12 months. The patient who had had no level measured commenced HPN one month before the audit. 49 patients were vitamin D insufficient (25–50 nmol/L) and 9 were deficient (<25 nmol/L). Of those with insufficiency 3 were offered supplementation, 26 were not, 6 had their Vitamin D dose increased and 14 remained on the same dose. 24 of the 49 patients with vitamin D insufficiency had levels>40 which would not necessarily warrant treatment. Of deficient patients 5 were offered supplements, 2 had their usual dose increased and 2 remained on the same dose. Of 42 patients with a normal vitamin D level 18 were taking supplements.
DEXA scanning was performed for 72 of 101 patients. Of the 29 not scanned 14 were vitamin D insufficient (n=10) or deficient (n=4).
52 patients took vitamin D supplements as follows: colecalciferol tablets n=45, buccal colecalciferol spray n=6, alfacalcidol tablets n=2 (renal team recommendation). One patient was taking colecalciferol and alfacalcidol.
Table Number of patients with vitamin D insufficiency plus deficiency out of total patients in each group by Pironi classification
Conclusion 81% of patients had their vitamin D monitored in line with NICE guidance. Only 9 of 49 patients with insufficient vitamin D and 7 of 9 patients with deficient vitamin D had evidence of action being taken, either by commencing supplementation or increasing their dose. All patients taking replacement were on an appropriate agent. HPN patients have at least one risk factor for osteoporosis however 29% of those included in this audit have not had DEXA scanning to aid their management. Further attention needs to be given to ensure that patients receive adequate Vitamin D replacement.
Disclosure of Interest None Declared
- Parenteral nutrition
- Vitamin D