RT Book, Section
A1 Sun, Di
A1 Appachi, Elumalai
A2 Usatine, Richard P.
A2 Sabella, Camille
A2 Smith, Mindy Ann
A2 Mayeaux, E.J.
A2 Chumley, Heidi S.
A2 Appachi, Elumalai
SR Print(0)
ID 1114879521
T1 Rickets
T2 The Color Atlas of Pediatrics
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-176701-9
LK accesspediatrics.mhmedical.com/content.aspx?aid=1114879521
RD 2023/05/29
AB A  2-year-old  boy  is  brought  to  the  pediatrician  by  his  mother,  who  reports  that  the  boy  appears  more  irritable  lately  and  does  not  seem  to  be  growing.  After  further  questioning,  the  mother  mentions  that  her  child  has  also  complained  of  leg  pain  and  a  “waddling”  gait.  On  exam,  the  boy  has  widening  of  the  wrists  and  bowing  of  his  legs  and  prominence  of  the  costochondral  junctions  (rachitic  rosary;  Figures  198-1  and  198-2).  The  pediatrician  asks  about  the  child’s  diet,  and  the  mother  reveals  that  the  patient  is  a  very  picky  eater  and  drinks  only  fruit  juice  that  is  not  fortified  with  vitamin  D.  The  pediatrician  is  concerned  about  rickets  and  orders  a  serum  alkaline  phosphatase,  which  is  elevated,  and  vitamin  D  level  (25-OH  Vitamin  D),  which  is  low.  X-ray  of  the  tibia  and  femur  demonstrated  widening  of  the  growth  plate  and  metaphysis  (Figure  198-3).  The  pediatrician  prescribes  vitamin  D  and  calcium  supplementation  for  the  child.  After  3  months  of  supplementation,  the  boy’s  symptoms  have  resolved  and  repeat  x-ray  showed  a  dense  zone  of  calcification  at  the  metaphysis  with  improvement  in  the  widened  growth  plate.