The patient responded nicely to SL administration of vitamin D 3 drops using a widely available, over-the-counter preparation with improvement in 25-hydroxyvitamin D (25D) levels. We report a patient with severe vitamin D deficiency who was resistant to oral vitamin D supplementation in the absence of known impaired vitamin D absorption. Medications that are administered via the sublingual (SL) route are rapidly absorbed through the SL blood vessels, bypassing the first-pass hepatic metabolism.
Additionally, other factors may play a role in the absorption of fat-soluble vitamins in the small intestine ( 1, 3, 4). These influence the release of vitamin D from the food matrix and its bioavailability. For example, it is influenced by several different factors after ingestion including gastric pH, gastric enzymes including pepsin and trypsin, and duodenal enzymes (proteases, amylase, and lipase).
Bioavailability of vitamin D differs among individuals due to variable absorption or altered metabolism in the body ( 2). Vitamin D plays a major role in regulating calcium and phosphorous levels in the body, with its deficiency leading to osteomalacia and rickets ( 1).
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