I remember with horror the pediatric burn unit when I did a surgical internship: seeing children with burns over most of their body; burns so deep muscle tissue was showing; children in such pain, both physical and psychological. I developed a deep respect for those who care for burned children.
In November of 2011, Dr. Gordon Klein, of the University of Texas Medical Branch and Shriners Burns Hospital, one of the heroes who do care for burned children, attempted to explain why burned children have such low calcium and vitamin D levels. However, he missed the most likely explanation.
In the past, I have written about the very recent discovery that even an elective artificial knee replacement metabolically clears (uses up) tremendous quantities of vitamin D and that even three months later vitamin D levels were still 20% lower than before surgery. Yes, the authors attempted to use free vs. bound and the inflammatory response affecting binding proteins but that explanation simply didn’t fit the data.
Reid D, et al. The relation between acute changes in the systemic inflammatory response and plasma 25-hydroxyvitamin D concentrations after elective knee arthroplasty. Am J Clin Nutr. 2011 May;93(5):1006-11. Epub 2011 Mar 16.
Like other vitamin D experts, I suspect injuries and illnesses use up (metabolically clear) tremendous quantities of vitamin D. First, vitamin D is a one-way street; it is not like vitamin A or vitamin K that the body reuses repeatedly. For vitamin D, it is one molecule of cholecalciferol in via the skin or mouth, and one molecule of calcitroic acid out in the urine.
Second, vitamin D is crucial to most of the inflammatory mechanisms involved in illness or injury. Take cathelicidin, the powerful broad-spectrum natural antibiotic and immune regulator that only vitamin D can upregulate (increase). Can you imagine how much cathelicidin these burned children are making, expending one precious molecule of vitamin D for every priceless molecule of cathelicidin? Vitamin D upregulates dozens, perhaps hundreds, of genes involved in healing injuries or fighting illnesses, all at the expense of vitamin D levels, which rapidly plummet.
Dr. Gordon Klein has my deepest respect, caring for these children. You can read his entire paper free; just click the first hyperlink above. He even called for more studies of how much vitamin D these children need. I’ll tell him now so he does not have to wait ten years for the studies. Burned children need to maintain blood levels around 50-80 ng/ml, which I believe will require mega doses the first few days, followed with high physiologic doses for a month, and followed with most likely, a high maintenance dose thereafter.