Single oral high-dose vitamin D3 prophylaxis in the elderly.

A poor vitamin D status is common in the elderly during the winter months. Because it is possible that hypovitaminosis D may be a cause of senile osteopenia, a simple method of prophylaxis would be useful. The single, oral, high-dose method was tested in two old-age homes, and the efficacy of vitamin D3 was compared with that of 25-hydroxyvitamin D3 (25-OHD3). The trials showed that 25-OHD3 caused a higher peak value in the serum 25-OHD levels in the second week than did vitamin D3. However, follow-up after four to five months showed that in those patients who received a single, oral dose of 25-OHD3, the serum 25-OHD levels had returned to the baseline low values, whereas in those patients who had had oral vitamin D3, the serum 25-OHD levels still remained significantly raised compared with the baseline values and were within normal limits. It is concluded that the single, oral, high-dose method using vitamin D3 is a safe and simple method of prophylaxis and could be used easily in large populations of elderly persons.

Subcutaneous infusions in the elderly.

1,850 subcutaneous infusions were given to 270 elderly patients (average age, 82) in a hospital geriatric department and in two nursing homes. The side effects were few and not serious. In 4 patients there was anasarca of the gluteal and genital regions but this disappeared promptly after giving diuretics. In a case of disseminated intravascular coagulation, ecchymoses appeared in the thighs. Sepsis, shock, tissue necrosis and other dangerous side effect mentioned in textbooks were not observed. The method is acceptable to most elderly patients and causes less discomfort than does the intravenous method. Since the infusion last only 2 to 4 hours, it enables the patient to be out of bed most of the day. Infusion by the subcutaneous route can be safely administered by trained nurses in institutions without a resident medical staff. It seems to be the method of choice for giving fluid supplements to elderly patients in nonemergency situations.

Inadequate status and impaired metabolism of vitamin D in the elderly.

The mean serum concentrations of 25-hydroxyvitamin D and of 24,25-dihydroxyvitamin D were significantly lower (P less than 0.01) in 82 elderly people than in 30 young control subjects. The levels in 30 elderly people confined to their rooms were 8.0 +/- 0.7 (SE) and 0.54 +/- 0.04 ng/ml, respectively; in 31 active old-age-home residents who spent part of their time outdoors, they were 11.4 +/- 0.8 and 0.82 +/- 0.08 ng/ml, respectively; and in 21 elderly farm workers, 14.6 +/- 1.4 and 0.98 +/- 0.10 ng/ml, respectively. In the young control subjects, the levels were 21.5 +/- 1.4 and 1.91 +/- 0.12 ng/ml, respectively. In addition, an intestinal absorption test with a standard oral dose of 25-hydroxyvitamin D3 showed that the serum 25-hydroxyvitamin D3 responses at 4 and 6 h were considerably depressed in 10 of the 20 elderly subjects in whom the test was performed.

Hypoglycaemic coma due to chlorpropamide: observations on twenty-two patients.

Twenty-two patients with chlorpropamide-induced hypoglycaemic coma were seen at a medical centre serving a region with a large geriatric population. The median age of the patients was 72; seven were over 80 and only one was under 60. Four patients died and in three of them death appeared to be connected with the hypoglycaemia. In two cases, the hypoglycaemia appeared in the postoperative period. Generally accepted contra-indications to the use of chlorpropamide were present in five of the eight patients under 70 and in four of the 14 patients over 70. If full precautions had been taken in presecribing chlorpropamide and if old age had been regarded as a contra-indication, the hypoglycaemia might have been prevented in 19 out of the 22 patients.

Postoperative hypoglycaemic coma associated with chlorpropamide.

A 72-year-old male being treated with chlorpropamide for diabetes mellitus had an emergency operation for a perforated gastric ulcer. Hypoglycaemic coma occurred after the operation.