Abstracts

Rationale: Patients (pts) who are on chronic antiepileptic drugs (AED)and/or nonambulatory are a vulnerable population for vitamin D deficiency and comprise a large portion of a general pediatric neurology outpatient clinic. In 2008 the American Academy of Pediatrics (AAP) recommended all children and adolescents receive 400 IU vitamin D or 1000 ml vitamin D fortified milk daily, with serum 25 OH vitamin D level >50 nmol/l (20 ng/ml). AAP recommendations regarding 'at risk' populations were to monitor serum 25 OH vitamin D level, and if the 25 OH vitamin D level is low, measure PTH (parathyroid hormone) and bone mineral status. We reviewed 380 consecutive pts in our outpatient neurology clinic to characterize the at risk population, adequacy of vitamin D supplement, and bone health monitoring. Methods: With IRB approval, charts of 380 consecutive patients were reviewed between March 9 and March 30, 2011. Data collected included antiepileptic drugs for the current visit and 2 previous years, ambulatory status, dietary supplements (multiple vitamins, vitamin D), and laboratory monitoring (vitamin D, PTH and Dexa scan) in the past 2 years. Pts (or caregivers) were specifically asked whether the pt was taking vitamins of food supplements by the Neurology nurses.Results: Of 380 pts, 95 were new pts and excluded from analysis. Of the remaining 285 pts, 152 (53%) were on AED > 6 months; 41 (14%) were nonambulatory; 37 (13%) were both nonambulatory and on chronic AED. Only 65 of 285 (23%) received any form of vitamin D supplement. 19 of 37 pts with both risk factors took any form of vitamin D supplement. Regarding monitoring, 14 of 152 pts on chronic AED (9%) had vitamin D level checked in the past 2 years; 8 of 41 nonambulatory pts had vitamin D level checked. 14 pts (5 % of 285) were nonambulatory, on AED, and on vitamin D supplementation. 6 of these 14 had a vitamin D level checked. None of the 285 pts had PTH measured or Dexa scan. Conclusions: In our outpatient general pediatric neurology clinic, over 50% have been on AED over 6 months and 14% are nonambulatory. The recommended vitamin D supplement is taken by <25% of all of our patients receiving ongoing care. The majority of at risk pts (on AED and nonambulatory) are not receiving vitamin D supplementation or monitoring for hypovitaminosis D. This study demonstrates the need for more rigorous vitamin D supplementation and monitoring of bone health status in vulnerable populations. This is an opportunity for the development and implementation of departmental recommendations for vitamin D supplementation and monitoring.