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subclinical vit D deficiency rickets is life threatining |
2 March 2004 |
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AbdelWahab T Elidrissy,
Professor of Pediatrics
KAhospital Jedah Saudi Arabia
Send letter to journal:
Re: subclinical vit D deficiency rickets is life threatining
elidrissytay{at}hotmail.com AbdelWahab T Elidrissy
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I am pleased to see this report and Iwould like to stress on the
importance of subclinical rickets as a cause of serious complications.Of
these complications is hypocalcaemic cardiomyopathy with frank heart
failure ,we have seen few cases responding dramatically to vit D therapy
and calcium supplementation.Also we have seen many cases of hypocalcemic
seizures leading to hypoxaemic cerebral draingement.We have reported that
maternal vit D deficiency is a major factor leading to early subclinical
rickets accordingly vitamin D supplementation is reommened during
pregnancy for the mother and to her breastfeeding infant in adequite
doses.
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Re: subclinical vit D deficiency rickets is life threatining |
3 March 2004 |
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Jean T Spence,
physician
Johns Hopkins University School of Medicine,
Janet R. Serwint
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Re: Re: subclinical vit D deficiency rickets is life threatining
jespence{at}jhmi.edu Jean T Spence, et al.
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We appreciate Dr. AbdelWahab's comments and welcome his international
perspective on this problem of subclinical vitamin D deficiency rickets.
While we agree that a patient has subclinical disease prior to the
development of clinical symptoms, our review was focused on the child
without clinical symptoms who may be identified by history to be at
potential risk. We emphasize the importance of intervening with treatment
prior to the development of morbidity. We concur that vitamin D
deficiency rickets must be prevented through vitamin D supplementation of
breastfed infants.
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The importance of alkaline phosphatase level in subclinical rickets |
25 September 2004 |
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Mohsen S Al-Atawi,
consultant pediatric endocrinlogist
king abdulaziz medical city - ER-saudi arabiad
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Re: The importance of alkaline phosphatase level in subclinical rickets
atawim{at}ngha.med.sa Mohsen S Al-Atawi
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The article of Jean T.Spence and Janet R. Serwint about the
subclinical vitamin D deficiency rickets firmly address the value of
obtaining serum alkaline phosphatase (AL)in any infant suspected to have
the disease even in face of complete lacking of clinical and biochemical
features suggastive of rickets . in my practice based on reviewing records
of 280 infants all below 24 months of age with vitamin D deficiency
rickets none of these infants had alkaline phosphatase less than 500 IU/L
. This furher adress the usefullness of alkaline phosphatase not only for
screening but as well to moniter the therapy progress.
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response to Dr. Al-Atawi's comments |
10 October 2004 |
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Jean T. Spence,
pediatrician
Johns Hopkins
Send letter to journal:
Re: response to Dr. Al-Atawi's comments
jespence{at}jhmi.edu Jean T. Spence
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We appreciate Dr. Al-Atawi's comments and reporting of his clinical
experience. Clearly alkaline phosphatase levels are elevated in many
patients with sub-clinical rickets as was true with our reported case.
However, as demonstrated in Pettifor's study of 44 infants in South
Africa, 7 of them had radiograph changes consistent with rickets. Another
7 had elevated alkaline phosphatase levels (>300). Only two of the
children with elevated alkaline phosphatase levels also had wrist changes
on radiograph. Thus Pettifor et al conclude that an elevated alkaline
phosphatase level is not diagnostic, and some children with radiographic
evidence of rickets simultaneously have normal alkaline phosphatase
levels. It is for this reason that we suggest screening for subclinical
vitamin D-deficiency rickets, as clinically indicated, using wrist
radiographs paired with 25-hydroxyvitamin D levels. Should the clinician
obtain an elevated alkaline phosphatase level, we agree with Dr. Al-Atawi
that further investigation for vitamin D-deficiency rickets is in order.
Jean T. Spence
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