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Spinal Cord injury outcome was better if got Vitamin D and progesterone within 4 hours – RCT 2016

Effects of progesterone and vitamin D on outcome of patients with acute traumatic spinal cord injury; a randomized, double-blind, placebo controlled study.

J Spinal Cord Med. 2016 May;39(3):272-80. doi: 10.1080/10790268.2015.1114224. Epub 2015 Dec 17.
Aminmansour B1, Asnaashari A1, Rezvani M1, Ghaffarpasand F2, Amin Noorian SM3, Saboori M1, Abdollahzadeh P4.

VitaminDWiki
  • Intramuscular injection of 0.5 mg/kg progesterone twice daily
  • 5µg/kg oral vitamin D3 twice daily up to 5 days
    = 32,000 IU daily for 80 kg (176 lbs) person (400 IU/day/kg) = total of 160,000 IU
       many other vitamin D studies use loading doses of 300,000 to 800,000 IU
       Some of the study participants might have achieved a useful level of vitamin D by day 5

A single loading dose of Vitamin D would have resulted in good level in 3 rather than 5 days


Overview Loading of vitamin D contains the following

If a person is, or is suspected to be, very vitamin D deficient a loading dose is typically given

  • Loading = repletion = quick replacement (previously known as Stoss)
  • Loading doses range in size from 100,000 IU to 1,000,000 IU of Vitamin D3
  • The size of the loading dose is a function of body weight - see below
    Unfortunately, some doctors persist in using Vitamin D2 instead of D3
  • Loading may be done as quickly as a single day, to as slowly as 3 months.
    It appears that spreading the loading dose over 4-20 days is a good compromise
  • Loading is typically oral, but sometimes by injection (I.M,)
  • The loading dose persists in the body for about 3 months
    The loading dose should be followed up with continuing maintenance
    Unfortunately, many doctors fail to follow-up with the maintenance dosing.
  • As about 1 in 300 people have some form of mild allergic reaction to vitamin D supplements,
    it appears prudent to test with a small amount of vitamin D before giving a loading dose
  • The causes of a mild allergic reaction appear to be: (in order of occurance)
    1) lack of magnesium - which can be easily added
    2) allergy to capsule contents - oil, additives (powder does not appear to cause any reaction)
    3) allergy to the tiny amount of D3 itself (allergy to wool) ( alternate: D3 made from plants )

 Download the PDF from VitaminDWiki

BACKGROUND:
Steroid hormones offer promising therapeutic perspectives during the acute phase of spinal cord injury (SCI) while the role of progesterone and vitamin D remain controversial. The aim of the current study was to investigate the effects of progesterone and vitamin D on functional outcome of patients with acute traumatic SCI.

METHODS:
This was a randomized clinical trial including 64 adult patients with acute traumatic SCI admitted within 8 hours of injury. All the patients received methylprednisolone on admission according to standard protocol (30 mg/kg as bolus dose and 15 mg/kg each 3 hours up to 24 hours). Patients were randomly assigned to receive intramuscular injection of 0.5 mg/kg progesterone twice daily and 5µg/kg oral vitamin D3 twice daily up to 5 days (n = 32) or placebo (n = 32). Patients were visited 6 days, 3 and 6 months after injury and motor and sensory function was assessed according to American Spinal Injury Association (ASIA) score.

RESULTS:
There was no significant difference between two study groups regarding age (P = 0.341), sex (P = 0.802) and therapy lag (P = 0.609). The motor powers and sensory function increased significantly after 6 months in both study groups. Those who received progesterone and vitamin D had significantly higher motor powers and sensory function after 6 months of therapy.

Those who received the therapy within 4 hours of injury, had significantly higher motor powers and sensory function 6 months after treatment in progesterone and vitamin D group. Therapy lag was negatively associated with 6-month motor powers and sensory function in progesterone and vitamin D group.

CONCLUSIONS:
Administration of progesterone and vitamin D in acute phase of traumatic SCI is associated with better functional recovery and outcome.

PMID: 26832888 PMCID: PMC5073761 DOI: 10.1080/10790268.2015.1114224

Created by admin. Last Modification: Tuesday January 16, 2018 10:56:55 UTC by admin. (Version 8)

Attached files

ID Name Comment Uploaded Size Downloads
9178 SCI 4 hours.pdf admin 13 Jan, 2018 16:38 257.73 Kb 8
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