Was to investigate the effect of treatment with an IM injection, a mega dose of
vitamin D3 (10,000 IU/kg) on the clinical, biochemical and radiological parameters of 40 rachitic children with
vitamin D deficiency (VDD) over a period of 3 months.
DESIGN: In this prospective study we evaluated the clinical, biochemical and radiological responses of an IM injection of
cholecalciferol (10,000 IU/kg) for 3 months.
RESULTS: At presentation, the most frequent manifestations were enlarged wrist joints,
hypotonia, irritability, cranial bossing, wide anterior fontanel,
bow legs, delayed teething and walking and Harrison's sulcus with chest rosaries. Short stature (length SDS < -2) was recorded in 30% of patients. Craniotabes and hypocalcemic
tetany were the least common presentations. In VDD children the most frequent biochemical abnormality was high
alkaline phosphatase (ALP) (100%), followed by low
phosphate (PO(4)) (75%) and low
calcium (Ca) (12.5%). One month
after treatment, serum Ca, PO(4) and 25(
OH)D concentrations were normal. Three months after the injection, serum level of ALP and
parathormone (PTH) decreased to normal. The majority of patients (87.5%) had serum 25(
OH)D level >or= 20 ng/ml, but some (12.5%) had level <20 ng/ml.
Hypercalcemia was not recorded in any patient during the 3-month-period. Significant cure of all symptoms and signs related to
vitamin D deficiency had been achieved in all children. Leg bowing showed significant improvement in all patients but was still evident in one third. Complete healing of the radiological evidence of
rickets was achieved in 95% of all children.
CONCLUSION: An IM injection of a mega dose of
cholecalciferol is a safe and effective
therapy for treatment of VDD
rickets in infants and toddlers with normalization of all the biochemical parameters and healing of radiological manifestations. Measurement of serum 25(
OH)D level is highly recommended in all short children with a clear need for a general
vitamin D supplementation for all infants and young children in Qatar.