Chronic treatment

a. Calcium. Oral calcium at a dose of 500-1000 mg elemental calcium per dose q6h. This can be given as liquid (calcium carbonate, 100 mg/mL; calcium glubionate, 25 mg/mL) or one of many tablet forms.

b. Vitamin D. Treat vitamin D deficiency with ergocalciferol drops at a dose of 800-8000 lU/day. Doses have been described in the literature up to 600,000 units given in a single day. For patients with renal failure, calcitriol can be given at a dose of 0.25-1 mcg/day. Patients with hypoparathyroidism, pseudohypoparathyroidism, and vitamin D-dependent rickets type 1 also require calcitriol therapy rather than ergocalciferol. This can be given orally or intravenously.

VI. Problem Case Diagnosis. The 1-week-old infant had late neonatal hypocalcemia, and a phosphorus level of 9.2 mg/dL. Infant was treated with IV calcium gluconate and placed on Similac PM 60/40. There was no evidence of DiGeorge syndrome or recurrence of hypocalcemia.

VII. Teaching Pearl: Question. In most cases of vitamin D-deficiency rickets, is the level of 1,25-dihydroxyvitamin D high, normal, or low?

VIII. Teaching Pearl: Answer. The 1,25-dihydroxyvitamin D levels are usually in the normal range, but this is inappropriate for the level of hypophosphatemia, hypocalcemia, and hyperparathyroidism that may be present.

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