![]() The ratio may be decreased with liver disease (due to a decrease in the formation of urea) and malnutrition. ![]() It may also be seen with increased protein, from BI bleed, or increased protein in the diet. An increased ratio may be due to a condition that causes a decrease in the flow of blood to the kidneys, such as CHF or dehydration. The ratio of BUN to creatinine is usually between 10:1 and 20:1. Population-based ranges correlate poorly with serum 25-OH-VitD concentrations that are associated with biologically and clinically relevant vitamin D effects and are therefore of limited clinical value. ![]() Population reference ranges for 25-OH-VitD vary widely depending on ethnic background, age, geographic location of the studied populations, and the sampling season. These reference ranges represent clinical decision values, based on the 2011 Institute of Medicine report, that apply to males and females of all ages, rather than population-based reference values. ![]() Patients with renal failure can have very high 25-OH-VitD levels without any signs of toxicity, as renal conversion to the active hormone 1,25-OH-VitD is impaired or absent. Most patients with toxicity have levels >150 ng/mL. TOTAL 25-HYDROXYVITAMIN D2 AND D3 (25-OH-VitD) 80 ng/mL (toxicity possible)***** *Could be associated with osteomalacia or rickets **May be associated with increased risk of osteoporosis or secondary hyperparathyroidism ***Optimum levels in the healthy population patients with bone disease may benefit from higher levels within this range ****Sustained levels >50 ng/mL 25OH-VitD along with prolonged calcium supplementation may lead to hypercalciuria and decreased renal function *****80 ng/mL is the lowest reported level associated with toxicity in patients without primary hyperparathyroidism who have normal renal function. CHILDREN* Males Premature (26-28 weeks): 1,219-9,799 ng/dL Premature (29-36 weeks): 346-8,911 ng/dL Full term (1-5 months): 229-3,104 ng/dL 6 months-364 days: 221-1,981 ng/dL 1-2 years: 35-712 ng/dL 3-6 years: or =18 years: 55-455 ng/dL Females > or =18 years: 31-455 ng/dL *Kushnir MM, Rockwood AL, Roberts WL, et al: Development and performance evaluation of a tandem mass spectrometry assay for 4 adrenal steroids.
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