Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive skeletal deformities, including bowing of the lower extremities, delayed motor milestones, and generalized irritability. History significant for inadequate dietary vitamin D intake, limited sunlight exposure, and exclusive breastfeeding without supplementation. Reports of muscle weakness, bone pain, and frequent fractures.
Clinical Examination Findings
Physical exam reveals frontal bossing, craniotabes, and widening of the wrists and ankles (metaphyseal cupping). Presence of rachitic rosary at the costochondral junctions and Harrisonโs groove noted. Gait assessment demonstrates varus or valgus deformity. Neurological exam shows hypotonia and delayed deep tendon reflexes.
Treatment Protocol
Initiate high-dose Vitamin D3 (cholecalciferol) therapy as per age-specific protocol. Supplementation with elemental calcium to ensure adequate mineralization. Monitor serum levels of 25-hydroxyvitamin D, calcium, phosphorus, and alkaline phosphatase. Orthopedic consultation for severe skeletal deformities. Review dietary intake and sun exposure habits.