Bone Abstracts

Background: A 9-month-old boy was diagnosed with rickets at the age of 6 months. He was born at term in India, following a normal pregnancy. Mother had taken folic acid and calcium, but not vitamin D, as this is the policy for pregnancy vitamins in Kerala.

Presenting problems: At 6 months of age he was seen for routine vaccination. The paediatrician noted a prominent forehead and swollen wrists. Wrist x-ray was said to show early rickets. Blood tests showed 25(OH) vitamin D < 7.5 nmol/l. The baby was treated with Colecalciferol 60 000 units/once a week for 6 weeks.

Repeat blood test 6 weeks later in India showed 25(OH) vitamin D >175 nmol/l. The calcium and phosphate levels were normal and Alkaline Phosphatase was 339 IU/l. The paediatrician changed the prescription to calcium and vitamin D syrup (Ca 250 mg/Vit D 125 units in 5 ml) 5 ml per day.

Clinical management: The baby was reviewed at 8 months of age by a GP in the UK. Serum vitamin D level was in the overdose range at 576 nmol/l, with normal levels of calcium and phosphate and alkaline phosphatase (262 IU/l). He was then seen in a paediatric metabolic bone clinic where no clinical, biochemical or radiological signs of rickets were seen. The original radiograph from India was reviewed and was normal. PTH and urine calcium were measured and were normal with no signs of toxicity. However the 1.25(OH)₂ vitamin D was high at >380 pmol/l.

Discussion: The dosage given in India (total vitamin D dose 360 000 units) is well within the current British dosage recommendations. These are that children aged 6 months–12 years be given 6000 units daily for 8–12 weeks (total dose of 504 000 units). This suggests that for small babies the current dose recommendations need revision.

Disclosure:: The authors declared no competing interests.