January Week 2: Rickets


Joiner, MD MHSA, Terence A., Carol Foster, MD, and Thomas Shope, MD. “The Many Faces of Vitamin D Deficiency Rickets.” Pediatrics in Review 21.9 (2000): 296-303

Wagner, MD, Carol L., and Frank R. Greer, MD. “Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents.” Pediatrics 122.5 (2008): 1142-152


1. Which is about equal to a liter?

a. 32 ounces
b. 4 cups
c. 2 pints
d. 1 quart
e. 16 of those ready-to-feed formula bottles we have in the hospital
f. All of the above.


2.  How much Vitamin D is recommended for all infants, children, and adolescents?

a.  400 IU per day beginning in the first few days of life 
b.  none, if they live in a sunny climate
c.  800 IU per day


3.  How much Vitamin D is in a liter of normal baby formula?

a.  400 IU
b.  none, that’s why they need the supplement
c.  800 IU


4. How much Vitamin D is in a liter of breastmilk from the average American woman?

a.  12-60 IU
b.  none, that’s why they need the supplement
c.  400 IU


5.  How many ounces of formula does a baby need to drink q3 hours to get the recommended amount of Vitamin D?

a. 4 ounces
b. 8 ounces
c. 32 ounces


6. How much Vitamin D is in one milliliter of over-the-counter baby vitamin supplements?

a. 400 IU
b. 100 IU
c. 800 IU


7.  What is the most common way Rickets is diagnosed?

a. incidentally, on physical exam or x-ray
b. failure to thrive
c. tetany


8. What is the most sensitive test for diagnosing Rickets due to Vitamin D deficiency?

a. 25-hydroxy Vitamin D level
b. 1,25-hydroxy Vitamin D level
c. calcium level


9.  What is the first thing you should do when treating Rickets in a patient with hypocalcemia?

a. Prevent the complications related to hypocalcemia by correcting critically low calcium levels 
b. Order long bone radiographs
c. Check a PTH level


10.  What should you prescribe to treat Vitamin D deficiency?

a. Vitamin D 800-1000 IU PO daily & Calcium 1000 mg PO daily until Alk Phos levels and Skeletal deformities return to normal
b. Vitamin D 400 IU PO daily 
c. Calcium 1200 mg PO daily


11. You are the Sick Resident and one of your favorite continuity patients comes in to see you.  It is an 11-month old boy, who slipped while crawling on a step and landed on his right arm in a funny way this morning.  He is still wearing his pajamas because he cried too much when his Mom tried to change his clothes, but you can see the forearm is definitely not straight.  You’re worried he may have fractured the arm, so you order an x-ray.  As you diligently check off his P-M-A in Centricity, your heart sinks…there’s no D-vi-sol.  Mom says she never got any Patient Instructions about Vitamin D supplementation from you.  ”Don’t worry Doc,” she says, “I’m still taking my prenatal vitamins.”  Yes, he’s still breastfeeding.  What do you hope Dr. Volberg does not see on the arm films?

a. a fracture
b. widening and/or a cup-shaped metaphysis
c. osteopenia
d. All of the above.