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Nutritional rickets in suburbia.
J Am Coll Nutr 1998; 17(6):637-41JA

Abstract

OBJECTIVE

Vitamin D deficiency continues to be a problem in pediatrics. This report presents four children, one Caucasian male and three African-American females aged 4 to 24 months who were treated for vitamin D deficiency rickets.

METHODS

One female was diagnosed in the Emergency Department during evaluation of a viral syndrome, another presented with hypocalcemic seizures and the third was a self-referral for evaluation of widened wrists. The male had biochemical rickets discovered incidentally during a hospitalization for pneumonia. All were breastfed without formula supplements. The 24-month female had severe cow and soy protein allergies and received multivitamin supplements intermittently. Birth order was from third to sixth child. Two families practiced Islam and the mothers wore veils. The females had a weight deficit for height. The females demonstrated a rachitic rosary, widening of the wrists and leg bowing. At diagnosis the serum calcium was 5.0-8.6 mg/dl, the inorganic phosphorus was 1.5-3.9 mg/dl and the alkaline phosphatase was 408-3324 U/L. The serum intact parathormone levels and the vitamin D levels were measured at Nichols Laboratories. The 25-OH vitamin D levels were 2-22 ng/ml and the 1,25(OH)2 vitamin D levels were 14-122 pg/ml. All had elevated parathormone levels. The three females had roentgenographic evidence of rickets. Two of the children also demonstrated iron deficiency.

RESULTS

All patients responded to Vitamin D supplements, beginning at 2000 IU for the male and 8,000-10,000 IU daily for the females. Two children were also given calcium supplements. The three females all showed complete healing of the rickets radiologically within six months. The serum intact parathormone demonstrated an inverse correlation with the serum calcium during recovery (r=-0.669; p<0.05).

CONCLUSION

Vitamin D deficiency does still occur. Breastfed children of multiparous mothers, with increased skin pigmentation, living in the higher latitudes are at increased risk and would benefit from vitamin D supplementation while breastfeeding.

Authors+Show Affiliations

Department of Pediatrics, Nassau County Medical Center, East Meadow, New York 11554, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

9853545

Citation

Pugliese, M T., et al. "Nutritional Rickets in Suburbia." Journal of the American College of Nutrition, vol. 17, no. 6, 1998, pp. 637-41.
Pugliese MT, Blumberg DL, Hludzinski J, et al. Nutritional rickets in suburbia. J Am Coll Nutr. 1998;17(6):637-41.
Pugliese, M. T., Blumberg, D. L., Hludzinski, J., & Kay, S. (1998). Nutritional rickets in suburbia. Journal of the American College of Nutrition, 17(6), pp. 637-41.
Pugliese MT, et al. Nutritional Rickets in Suburbia. J Am Coll Nutr. 1998;17(6):637-41. PubMed PMID: 9853545.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nutritional rickets in suburbia. AU - Pugliese,M T, AU - Blumberg,D L, AU - Hludzinski,J, AU - Kay,S, PY - 1998/12/16/pubmed PY - 1998/12/16/medline PY - 1998/12/16/entrez SP - 637 EP - 41 JF - Journal of the American College of Nutrition JO - J Am Coll Nutr VL - 17 IS - 6 N2 - OBJECTIVE: Vitamin D deficiency continues to be a problem in pediatrics. This report presents four children, one Caucasian male and three African-American females aged 4 to 24 months who were treated for vitamin D deficiency rickets. METHODS: One female was diagnosed in the Emergency Department during evaluation of a viral syndrome, another presented with hypocalcemic seizures and the third was a self-referral for evaluation of widened wrists. The male had biochemical rickets discovered incidentally during a hospitalization for pneumonia. All were breastfed without formula supplements. The 24-month female had severe cow and soy protein allergies and received multivitamin supplements intermittently. Birth order was from third to sixth child. Two families practiced Islam and the mothers wore veils. The females had a weight deficit for height. The females demonstrated a rachitic rosary, widening of the wrists and leg bowing. At diagnosis the serum calcium was 5.0-8.6 mg/dl, the inorganic phosphorus was 1.5-3.9 mg/dl and the alkaline phosphatase was 408-3324 U/L. The serum intact parathormone levels and the vitamin D levels were measured at Nichols Laboratories. The 25-OH vitamin D levels were 2-22 ng/ml and the 1,25(OH)2 vitamin D levels were 14-122 pg/ml. All had elevated parathormone levels. The three females had roentgenographic evidence of rickets. Two of the children also demonstrated iron deficiency. RESULTS: All patients responded to Vitamin D supplements, beginning at 2000 IU for the male and 8,000-10,000 IU daily for the females. Two children were also given calcium supplements. The three females all showed complete healing of the rickets radiologically within six months. The serum intact parathormone demonstrated an inverse correlation with the serum calcium during recovery (r=-0.669; p<0.05). CONCLUSION: Vitamin D deficiency does still occur. Breastfed children of multiparous mothers, with increased skin pigmentation, living in the higher latitudes are at increased risk and would benefit from vitamin D supplementation while breastfeeding. SN - 0731-5724 UR - https://www.unboundmedicine.com/medline/citation/9853545/Nutritional_rickets_in_suburbia_ L2 - http://www.tandfonline.com/doi/full/10.1080/07315724.1998.10718814 DB - PRIME DP - Unbound Medicine ER -