Nutritional Rickets

Averil Tam
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Averil Tam
Created by Averil Tam over 1 year ago
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Question Answer
1. Nutritional rickets is most often due to: A. Renal disorder leading to urinary phosphate loss B. Dietary calcium deficiency C. Combination of vitamin D deficiency and dietary calcium deficiency D. Vitamin D deficiency C. Usually a combination of vitamin D deficiency and at least dietary calcium insufficiency. A - no, this is cause in genetic rickets such as XLH. B - no, unusual for it to be the only cause. D - no, need to have dietary calcium deficiency too.
2. In the absence of symptomatic hypocalcaemia, optimal treatment of nutritional rickets is: A. Calcium B. Calcium and cholecalciferol C. Calcitriol D. Cholecalciferol B. This is optimal treatment to enable mineralisation of skeleton. A - no, never alone. C - no,only consider adding to calcium if severe hypocalcaemia. D - no, never alone.
3. Prevention of nutritional rickets: A. Supplement all infants with 400 IU cholecalciferol for first 12 months B. Supplement ‘at risk’ infants with 400 IU cholecalciferol for first 12 months C. Supplement all breast fed infants with 400 IU cholecalciferol for first 12 months D. Supplement vitamin D deficient infants with 400 IU cholecalciferol for first 12 months A. B & C will miss children who may still develop nutritional rickets. D - there is no need to check vitamin D levels, just treat.
4. What is the definition of Vitamin D deficiency in children? Deficiency is 25OHD <30 nmol/L. Insufficiency 30-50, sufficiency >50.
5. What is the definition of deficient calcium intake in children? <300 mg/day. Insufficiency 300-500, sufficiency >500mg.
5. How is Rickets diagnosed and what are the potential complications/sequelae? Radiological diagnosis, occurring when low calcium intake is combined with low 25OHD (LCMS). Affects cardiac & skeletal muscle, and bones. Features are reversible and fully preventable, but long-term sequelae and deaths if untreated.
6. From a public health perspective, supplementation should be offered to which groups? ALL infants 1st year of life (400IU, 10μg). ALL pregnant mothers (600IU, 15μg). ALL risk groups, for life. Food fortification programs should be considered for high-risk populations.