Evaluating the Impact of Vitamin D Supplementation on Healing Bed Sores in ICU.

inclusion criteria:

1-Critically ill patients with bed sores Grade (1-2), (non-light) exudate admitted to ICUs.

2- Serum vitamin D <20 ng/mL. 3- Both genders. 4- Age: 18-60 years. 5- enteral access in place to enable delivery of vitamin D3 and are deemed to be able to tolerate enteral drug administration.

6- GCS > 9. 7- Serum Calcium (8-10 mg/dl). 8- Serum creatinine less than 1.4 mg/dL. exclusion criteria:

1. Refusal of the legal guardian of the patient to participate in the study.
2. Current pregnancy or lactating mother.
3. Patients who are terminally ill and expected to die in less than 72 hours.
4. Renal dysfunction (GFR < 30 mL/min) and the onset of dialysis during the study.
5. Vitamin D supplementation in the last 15 days.
6. Hypo/hyper-calcemia (adjusted calcium less than 8 mg/dL or above 10).
7. History of disorders associated with hypercalcemia (history of cancer with history of hypercalcemia within the past 1 year, hyperparathyroidism, sarcoidosis, nephrolithiasis).
8. History of parathyroid dysfunction.
9. Ongoing shock, [defined as unstable blood pressure despite vasopressor support and mean arterial pressure (MAP) < 60 mm Hg on at least 3 consecutive readings within a 3-hour period prior to study entry].
10. History of malabsorption syndromes; gastrointestinal intolerance (diarrhea, vomiting, or increased nasogastric aspirates).

11. History of adverse reaction to vitamin D supplementation. 12. known history of cirrhosis. 13. Patients taking any medications that have serious drug interactions with vitamin D like statins, orlistat, aluminum hydroxide (interfere with the absorption of vitamin D), digoxin (can enhance the effects of vitamin D on the heart leading to potential toxicity), and certain diuretics (can cause high calcium levels).