More than half of the patients were 6 months to 2 years old and no sex difference was seen. Two patients were more than 3 years and twelve patients were 3-6 months of age. Delayed milestones, delayed teething and recurrent chest infections were found in 35%, 23% and 10% of patients respectively. Twenty three per cent of the patients presented with convulsions of which one was older than 12 months. All these patients had significant hypocalcemia, which was invariably preci-pitated by fever. All patients were well nourished and had skeletal features of rickets.

Biochemical investigations showed hypo-calcemia in 35% patients. Despite vitamin D and calcium supplementation, 11% patients remained hypocalcemic at 6 weeks follow up; 35.5% patients still had raised alkaline phosphatase (>650). All mothers of 23% patients with hypocalcemic convulsions were investigated and all were found to have hypocalcemia with normal phosphorus and alkaline phosphatase levels.

Injectable calcium was given to all patients with hypocalcemic convulsions and oral calcium gluconate (100 mg/Kg/day) was given to all others till calcium returned to normal. All patients <3 months of age were given intramuscular injection of vitamin D 3 lac IU and >3 months 6 lac IU. Repeat dose of vitamin D at 6 weeks and 12 weeks follow up were given to those who had persistently high alkaline phosphatase. No patient treated with vitamin D reported any signs of toxicity. Injectable vitamin D instead of oral was given in view of ensuring compliance(1).

Radiological healing was seen in more than three fourth of patients at 6 weeks and in all by 12 weeks. There was improvement in milestones, eruption of teeth and improvement in bony deformities in all the patients.

One percent of pediatric patients attending this hospital were found to have rickets, as also reported earlier(2). However a study from Mumbai reported 5.3% incidence of rickets due to poor penetration of sunlight through polluted atmosphere of the metropolitan cities(1).

Key message of this study is that people of this area should be given information regarding the importance of sunlight in prevention of this disease through press and health workers, as inadequate exposure to sunlight appears to be the main cause of vitamin D deficiency rickets in our study. Earliest treatment is recommended to avoid permanent disabilities.

Anushma Sharma,
D.N. Virmani,
Department of Pediatrics,
Kasturba Hospital, Delhi 110 002, India.
E-mail: [email protected]
 

1. Aggarwal JR, Sheth SC. Tibrewala NS. Rickets, a study of 300 cases. Indian Pediatr 1969; 6: 792-298.

2. Manchandar SS and Lal H. The challenge of rickets in Punjab. Indian J Pediatr 1972; 39: 52-57.