Doctor appointment

I have spoken to my doctor at the appointment this evening. She has prescribed me folic acid to take once a day, ferrous fumarate she wants me to take once a day, vitamin D she has prescribed me 800iu and vitamin B12 she does not want me to start because she is testing me for intrinsic factor antibodies. Does all of this sound fair

Ferritin 16 range 15 to 150

Folate 3.6 range 4.6 to 18.7

Vitamin B12 151 range 180 to 900

Total vitamin D 20.3 range below 25 severe vitamin D deficiency. Patient may need pharmacological preparations

6 Replies

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  • Topaz33 I see you had some replies on the PA forum. I'm no expert but going by what you were advised on there it seems to have been recommended to start B12 injections before starting folic acid. I would pop back over there, start a new thread and check on that, tell them what your GP is proposing and see if it's the right way round.

    With your ferritin that low you should be taking one FF tablet twice a day. One a day is for *prevention* of anaemia. Have a look at the patient information leaflet. Take your iron tablets with 1000mg Vit C to aid absorption and help prevent constipation.

    How many of the 800iu D3 per day has she prescribed? If only one then 800iu D3 will hardly raise the Vit D level of a sunburnt flea. That is far too low.

    You can look up online NHS guidelines for treating Vit D deficiency for your area, but as an example Cumbria area states this:

    "8. Treatment of Deficiency

    The treatment of choice is oral calciferol in the form of either ergocalciferol (yeast derived vitamin D2) or colecalciferol (fish or lanolin derived vitamin D3). Tablets, capsules and oily suspensions are available. Short-acting, potent vitamin D analogues such as alfacalcidol (1 α-hydroxycholecalciferol, One-Alpha®) or calcitriol are ineffective in correcting vitamin D deficiency and may lead to dangerous hypercalcaemia in this situation.

    The usual principle of therapy is to replenish the vitamin D stores over 8 to 12 weeks with high does calciferol therapy and then to continue a lower maintenance dose. Large bolus doses are also highly effective. Oral treatment is believed to be better absorbed than IM.

    There is a high therapeutic index for calciferol. It has been estimated that a regular daily dose of 1000IU raises serum 25-OHD by 24nmol/L; vitamin D toxicity has only been observed with 25-OHD values above 500nmol/L.

    Few, if any, people have significant contra-indications to calciferol therapy and toxicity (hypercalcaemia) is very rare. Pre-existing hypercalcaemic disorders, generally hyperparathyroidism or sarcoidosis, do however require liaison with secondary care before any treatment is instituted. Individuals with renal stones or nephrocalcinosis can safely be given vitamin D, but concomitant calcium therapy should be avoided.

    For adults with deficiency, a loading dose of approximately 300,000 IU is given in divided doses over 6 to10 weeks (see Section 8 for regimes). Patients should be aware of the need to supplement their diet thereafter.

    In adults with severe malabsorption, or those in whom concordance with oral therapy is suspect, an intramuscular does of 300,000 IU monthly for 3 months followed by the same dose every 2-3 months is an alternative.

    Adjusted serum calcium should be checked 1 month after completing the loading regimen or after starting vitamin D supplementation in case primary hyperparathyroidism has been unmasked.

    Routine monitoring of serum 25-OHD is generally unnecessary but may be appropriate in patients with symptomatic vitamin D deficiency or malabsorption and where poor compliance with medication is suspected.

    As few adults have truly reversible risk factors for vitamin D deficiency, the assumption should be that supplementation will be needed lifelong following treatment for deficiency, or lifelong during winter months (dependent upon latitude and dress habits).

    Deficiency Treatment Regimens (25-OHD <25nmol/L)

    Where rapid correction of vitamin D deficiency is required, such as in patients with symptomatic disease or about to start treatment with a potent antiresorptive agent (zoledronate or denosumab), the recommended treatment regimen is based on fixed loading doses followed by regular maintenance therapy.

    Where correction of vitamin D deficiency is less urgent and when co-prescribing vitamin D supplements with an oral antiresorptive agent, maintenance therapy may be started without the use of loading doses.

    Loading regimens for treatment of deficiency up to a total of approximately 300,000 IU given either as weekly or daily split doses. The exact regimen will depend on the local availability of vitamin D preparations but will include:

    Dose / Frequency / Duration / Total dose

    50,000 IU / Once weekly / 6 weeks / 300,000 IU

    20,000 IU / Twice weekly / 7 weeks / 280,000 IU

    800 IU / Five a day / 10 weeks / 280,000 IU

    See Appendix 1 for recommended preparations.

    Supplements should be taken with food to aid absorption.

    Calcium/vitamin D combinations should not be used as sources of vitamin D for the above regimens, given the resulting high dosing of calcium.

    Maintenance regimens may be considered 1 month after loading with doses equivalent to 800 to 2000 IU daily (occasionally up to 4,000 IU daily), given either daily or intermittently at a higher equivalent dose.

    Fultium® and Desunin® are licensed preparations suitable for maintenance therapy."

    So you can see that you should have been given loading doses as your level of 20.3 is classed as severe dedificiency.

  • Thanks I am not keen on taking the vitamin D tablets they give me upset stomach. I have been given 2 boxes of these tablets and she has said for me to take one a day.

  • It's up to you what you do but usual advice here for your level of Vit D would be to buy some D3 softgels 5000iu like these

    bodykind.com/product/2463-b...

    Take 10,000iu daily for 6-8 weeks then reduce to 5000iu daily. Retest in May and if you've reached the recommended level of 100-150nmol/L then take 5000iu alternate days as a maintenance dose.

    Those softgels contain only two ingredients - D3 and olive oil to aid absorption.

    Taking the co-factors mentioned in your previous thread are important.

  • I believe taking folic acid can mask pernicious anaemia and your B12 is so very low and I think you'd be having symptoms due to that. She should have prescribed Vit D3 for you and I think you will get B12 injections seeing it is so low.

    Members will respond to re your other results ;)

  • Thanks I was prescribed vitamin D3 800iu but I was prescribed this before and I didn't get on with it. Doctor said that was the only supplement they prescribe

  • Vitamin D is under prescribed. My endo prescribed Vitamin D3 drops and the target range for Vit D level is set at 75 nnomols.

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