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Pediatric Problem Solving – Case 26
A 14 month old infant presents to clinic because of poor weight gain and delayed walking . History revealed exclusive breast feeding with little baby food. On examination he has large head, distended abdomen, and palpable swellings at costochondral junctions.
What is the expected laboratory finding in this infant ?
A. Low calcium.
B. Low alkaline phosphatase .
C. Low phosphorus.
D. None of the above.
Explanation of the case:
14 month old infant, exclusive breast feeding without vit. D supplementation. Delayed walking, large head, distended abdomen and palpable swelling at costochondral junctions= rosary beads (skeletal and thoracic manifestations of rickets). This is typical case of infantile vitamin D deficiency rickets.
Choice A: Points against: serum Ca level is usually normal in case of rickets and decreases only in certain cases as parathyroid exhaustion, severe cases and shock therapy with vit. D as it causes deposition of blood Ca in bone.
Choice B: Points Against: serum level of alkaline phosphatase increases in case of rickets.
Choice C: (the right choice) Points with: serum level of phosphorus markedly decrease in case of rickets.
Choice D: Points against: there is already one correct answer..
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