Sistematik D Vitamini Tedavi Ajanları, Biyoyararlanımı ve Tedavi Yönetimi
Özet
D vitamininin kalsiyum homeostazisi ve kemik metabolizmasındaki kritik rolünü ele alan bu metinde, eksikliğinin çocuklarda rikets ve osteomalaziye, erişkinlerde ise osteomalazi ve osteoporoza yol açtığı belirtilmektedir. Ayrıca kanser, kalp damar hastalıkları, diyabet ve depresyon gibi durumlarla da ilişkili olan bu vitaminin %80-90'ı UVB ışınlarıyla deride sentezlenirken, yalnızca küçük bir kısmı besinlerle alınır. D2 ve D3 olmak üzere iki formu bulunan vitaminin, son çalışmalara göre D3 formunun biyoyararlanımının ve stabilitesinin daha yüksek olduğu kanıtlanmıştır. Yağda çözünen bir vitamin olduğu için yağlı gıdalarla ve en büyük öğünle alınması emilimini artırırken; obezite, çölyak gibi emilim bozuklukları ve gastrik cerrahi gibi durumlar serum düzeyini düşürür. CYP3A4 enzim sistemini kullanan antiepileptikler ve glukokortikoidler gibi bazı ilaçların katabolizmayı artırarak D vitamini seviyelerini azaltabileceği ve tiazid diüretiklerle kullanımında hiperkalsemi riskinin arttığı vurgulanmaktadır. Tedavide günlük dozlar veya "Stoss tedavisi" denilen yüksek tek dozlar tercih edilebilir. Türkiye’de sadece D vitamini (kolekalsiferol, alfakalsidol, kalsitriol) içeren veya kalsiyum, magnezyum ve K vitamini ile kombine edilmiş kapsül, tablet, damla ve ampul formları mevcuttur. Serum 25(OH)D düzeyinin 150 ng/ml'yi aşması durumunda ise konfüzyon, kusma, dehidratasyon ve metastatik kalsifikasyon gibi ciddi klinik bulgularla seyreden D vitamini intoksikasyonu (hipervitaminozis D) ortaya çıkabilir.
This text, which addresses the critical role of vitamin D in calcium homeostasis and bone metabolism, states that its deficiency leads to rickets and osteomalacia in children, and osteomalacia and osteoporosis in adults. Additionally associated with conditions such as cancer, cardiovascular diseases, diabetes, and depression, 80-90% of this vitamin is synthesized in the skin via UVB rays, while only a small portion is obtained through diet. Having two forms as D2 and D3, recent studies have proven that the D3 form has higher bioavailability and stability. Since it is a fat-soluble vitamin, ingestion with fatty foods and the largest meal increases its absorption, whereas conditions like obesity, malabsorption disorders such as celiac disease, and gastric surgery lower serum levels. It is emphasized that certain drugs using the CYP3A4 enzyme system, like antiepileptics and glucocorticoids, can decrease vitamin D levels by increasing catabolism, and its use with thiazide diuretics raises the risk of hypercalcemia. Daily doses or single high doses called "Stoss therapy" can be preferred in treatment. In Turkey, capsule, tablet, drop, and ampoule forms containing only vitamin D (cholecalciferol, alfacalcidol, calcitriol) or combined with calcium, magnesium, and vitamin K are available. If serum 25(OH)D levels exceed 150 ng/ml, vitamin D intoxication (hypervitaminosis D) can occur, presenting with severe clinical manifestations such as confusion, vomiting, dehydration, and metastatic calcification.
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