What Do The Following Lab Test Results Indicate?

Posted on Fri, 13 May 2016

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Fri, 13 May 2016 Answered on

Wed, 22 Jun 2016 Last reviewed on

Question : My vitamin D levels came back from the lab. My d2 was a 38 and my d3 is a 13. What's the difference? Are both values fine?

Answered by Dr. Tushar Kanti Biswas (29 minutes later)

Vitamin D from plant sources is in the form of vitamin D2, whereas that from animal sources is vitamin D3.fThese two forms have equivalent biologic activity and are activated equally well by the vitamin D hydroxylases in humans.Normal
Vitamin D 25-hydroxy, total 30–100 ng/mL.
You have Vit D deficiency.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Tushar Kanti Biswas (16 minutes later)

I just got off of a 3 month therapy of vitamin D 50,000 once a week. My first levels came back at a 9 which is why I was put on it to begin with in January. The minimum is 30, so why is 38 deficient if I'm above that? Can I just go out into the sun more? Do I need to bring my d3 up? If I do, how? I don't like taking pills unless absolutely necessary.

Answered by Dr. Tushar Kanti Biswas (1 hour later)

Brief Answer:
Vitamin D deficiency

Detailed Answer:
Vitamin D deficiency can be treated by the oral administration of 50,000 IU/week for 6–8 weeks followed by a maintenance dose of 800 IU/d (100 μg/d) from food and supplements once normal plasma levels have been attained.

You need to be on maintenance dose of Vitamin D 800 IU/d now.

Otherwise the consumption of fortified or enriched foods as well as suberythemal sun exposure are considered adequate to prevent vitamin D deficiency.

The physiologic effects of vitamin D2 and vitamin D3 are identical
when these vitamins are ingested over long periods.

Please upload all your laboratory reports.

Regards

Dr. T.K. Biswas M.D. XXXXXXX

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Tushar Kanti Biswas (23 minutes later)

I have uploaded labs from 5/2/16 which are the most recent. I can also upload the ones from January if needed.

Answered by Dr. Tushar Kanti Biswas (7 hours later)

Brief Answer:
Vitamin D deficiency

Detailed Answer:
I don find any laboratory report attached.There may be some technical problem.
Please try again.

Dr. T.K. Biswas M.D. XXXXXXX

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Tushar Kanti Biswas (12 minutes later)

Can you see them now?

Answered by Dr. Tushar Kanti Biswas (10 hours later)

Brief Answer:
Vitamin D deficiency

Detailed Answer:
Vitamin D 3 is cholecalciferol and vitamin D 2 is ergocalciferol.
Cholecalciferol is produced by the ultraviolet irradiation of dietary 7-dehydrocholesterol (provitamin D 3) in the skin. Ergocalciferol is also the result of the exposure of ergosterol (provitamin D2) to ultraviolet light.
Vitamin D2 (ergocalciferol) is obtained from plant sources and is the chemical form found in some supplement.

Ergocalciferol differs from cholecalciferol in having an extra methyl group at C-24 and a double bond at C-22,23.

The active form of vitamin D is 1,25(OH)2D.

I find as on 05.2.2016 Vitamin D3 ,1,25(OH)2 is low (13) and
Vitamin D2 ,1,25(OH)2 is 38 (within sufficient range).

However the best measure of the vitamin D status in humans is the plasma 25(OH)D concentration.

Severe vitamin D deficiency can be treated with pharmacologic repletion
initially (50,000 IU weekly for 3–12 weeks), followed by maintenance
therapy (800 IU daily).

It is unusual to have Vitamin D3 ,1,25(OH)2 still in deficient range after oral administration of Vitamin D 50,000 IU/week for 12 weeks .Hence other factors like malabsorption needs to be considered.

Cholecalciferol is also available in fatty fish (for example, cod), eggs, and chicken liver and you can have these dietary supplements if you do not want to continue with Vitamin D orally(don't like taking pills).

Food (unless fortified) contains only limited amounts of vitamin D.

Dr. T.K. Biswas M.D. XXXXXXX

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Tushar Kanti Biswas (1 hour later)

So to clarify, if I want to take a supplement I need to take 800 IU weekly or daily? Do I need to be taking d2 or d3? In the form of choecalciferol or do I need ergocalciferol? Or both?

And if I choose not to use supplements my best bet is through vitamin d fortified foods and the sun?

Answered by Dr. Tushar Kanti Biswas (1 hour later)

Brief Answer:
Vitamin D deficiency

Detailed Answer:
You have to take Vit D (choecalciferol i.e Vitamin D3) 1000 units daily;800 units as prescribed in XXXXXXX is not available here.

All breads and butter are routinely fortified with Vitamin D,for this purpose.You can check the label with details of added vitamins.

Dr. T.K. Biswas M.D. XXXXXXX

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Above answer was peer-reviewed by : Dr. Arnab Banerjee