Therapeutic Response and Effect on the Kidney of 100 Units Vitamin D 



181 



responded to 50 units of vitamin D. Fig. 3 shows the relation between the changes in 

 the — - and the changes in the serum calcium and serum phosphorus in one patient 



Ccr 



p 



with severe osteomalacia. When the '' fell the serum calcium fell; the serum phos- 



Pgtienfs offerporfial gosfrectom y 

 Vit D2 /0(>i.u.'M\ I I I 



wUh 

 without 



osteomo/ocia 



Fig. 2. Effect of daily 

 Cp/Cer in 3 patients 



6 8 



Days 



jections 100 units 

 ith osteomalacia 



itamin D 2 on 

 nd 2 patients 



Fig. 3. The serum 

 a patient with 



injections of 100 units 



ate and Cp/Qr in 

 d with four daily 

 tamin D 2 



phorus hardly changed. We draw 3 conclusions from these and other studies we have 

 made: 



1. The " may not be raised in osteomalacia. 



Ccr 



2. When it is raised it may fall with the administration of 100 units of vitamin 

 Do daily for 4 days. 



3. In the patient whose serum calcium fell, the fall 

 to a suppression of the parathyroid activity. The data suggest that a small dose of 

 vitamin D may directly influence the tubular reabsorption of phosphorus in patients 

 with osteomalacia. 



C,, 



ild 



ibuted 



Conclusion 



Patients with osteomalacia after gastrectomy get better with a dose of vitamin D^ 

 equivalent to 130 units daily. While we do not suggest that this dose produces an 

 optimal rate of healing, the clinical and biochemical response to this minute dose 

 shows that these patients have a simple deficiency of vitamin D. The factors con- 

 tributing to this deficiency have not been discussed. They involve both the patients' 

 dietary intake which can be very small, and the patients' ability to absorb vitamin D, 

 which may be impaired. 



