Clinical, biochemical and radiological manifestations of severe vitamin d deficiency in adolescents versus children: response to therapy.
Georgian Med News. 2012 Sep;(210):58-64.
[Article in English, Georgian]
Soliman A, De Sanctis V, Adel A, El Awwa A, Bedair S.
Department of Pediatrics and Radiology, Hamad Medical Center, Doha, Qatar.
Objectives: to compare clinical, biochemical and radiological manifestations of severe vitamin D deficiency (VDD - serum 25 OH - vitamin D level <10 ng/ml) in adolescents and children and to investigate the effects of an intramuscular injection (IM) of vitamin D3 megadose.
Design: in this prospective study 36 adolescents and 45 children with severe VDD were studied. An IM dose (10,000 IU/kg, max 600,000 IU) of cholecalciferol was injected and parameters of calcium homeostasis were measured at intervals of 3 months.
Results: at presentation, infants and young children (age 1.9 ± 0.5 years) with severe VDD had
- enlarged wrist joints (42/45),
- cranial bossing (39/45),
- wide anterior fontanel (27/45),
- Harrison's sulcus (11/45) ,
- chest rosaries (27/45),
- bow legs (29/45),
- delayed teething (40/45),
- delayed motor milestones (36/45),
- short stature (length/height SDS <-2)(12/45),
- craniotabes (4/45) and
- hypocalcemic tetany ( 11/45).
The most frequent biochemical abnormality was
- high alkaline phosphatase (ALP) (45/45), followed by
- low phosphate (PO4) (36/45) and
- low calcium (Ca) (8/45).
Adolescents with severe VDD presented with
- pain in weight bearing joints, back, thighs, knees, and calves (30/36)
- difficulty walking and/or climbing stairs and/or running (8/36),
- muscle cramps and/or facial twitches and/or carpopedal spasms (2/36) and
- genu valgum (2/36).
Biochemical serum abnormalities included
- high ALP (31/36),
- low phosphate (10/36) and
- low Ca (4/36).
Variable radiological manifestations due to VDD were detected in
- all children (45/45) and in
- some of adolescents (19/35).
Two different radiological patterns have been recognized in adolescents. Three months after injecting a mega dose of cholecalciferol all biochemical abnormalities were corrected with significant improvement of symptoms related to VDD had been reported in
- all children (45/45) and in the
- majority (33/36) of adolescents with VDD.
3-6 months after the injection, complete healing of the radiological evidence of VDD was achieved in
- all rachitic children and the
- majority of adolescents (16/19).
Conclusion: it appears that adolescents adapt better to severe VDD compared to infants, with less severe clinical, biochemical and radiological manifestations. An IM mega dose of cholecalciferol is effective therapy for treatment of VDD in children and adolescents for 3 months but not for 6 months.;
PDF is attached at the bottom of this page: pg 58+
A better schedule would probably have been less dose, and repeatedly: say 3,000 IU/kg monthly
- All items in category Megadose/Loading Dose and Vitamin D
- Overview of Rickets and Vitamin D
- 600000 IU dose raised youth vitamin D level by 60 ng in 3 days – July 2010
- Megadose injection of up to 600,000 IU vitamin D3 every three months for adolescents - April 2010 same author as study on this page
- Overview Loading of vitamin D which includes the following chart