M Alam Khan, Muhammad Ali, Ayesha Anwar, Sadia Shabir, Qazi Mumtaz, Nayab Fatima, Akmal L Chishti, H Hamid

Treatment Outcome of Oral Versus Injectable Vitamin D in Nutritional Rickets in Children

M Alam Khan, Muhammad Ali, Ayesha Anwar, Sadia Shabir, Qazi Mumtaz, Nayab Fatima, Akmal L Chishti, H Hamid



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ABSTRACT

 

Background: Rickets is a disease of growing bones which occurs before fusion of epiphyses. It is defined as failure of mineralization of growing bone or osteoid tissue. Vitamin D comes from two sources sunlight and diet. Treatment of vitamin D deficient rickets includes daily supplementation of vitamin D compared to stoss dose of vitamin D given orally or in injectable form.

Aim: To determine the treatment outcome of oral (mega dose or daily vitamin D) versus injectable mega dose in the treatment of nutritional rickets in children.

Method: This Randomized controlled trial was conducted atDepartment of Pediatric Medicine Mayo Hospital, Lahore from Jan 2015 to Jan 2017.Total 198 patients fulfilled the criteria were selected. All children were allocated into 3 groups, A, B & C. Treatment allocation was done using Lottery method. Group-A received oral mega dose of vitamin in a dose of 200,000 units, Group-B received injectable vitamin D in form of 200,000 units and Group-C was given vitamin D daily, 5000 units if age less than one year and 6000 units if more than one year for 30 days. All the children were followed up for two more visits at day 30 & 90. Clinical, biochemical & radiological data obtained at admission and follow-up was recorded.

Results: The average age of patients was 13.22 ± 8.21 months with 121(61%) male and 77(39%) female cases in this study. At 3rd month the weight gain was highest in group-B (1.09±0.55kg), followed by group-A (0.635±0.28kg) then group-C (0.36±0.31kg). This was statistically significant p-value < 0.0001. Mean calcium level at 3rd month in group-B was 9.04±0.33 mg/dl while the mean calcium level in group A & C, were 8.81±0.29 and 8.83±0.34 mg/dl respectively, with significantly higher levels in group B in comparison to group A & group C, p-value < 0.001. The mean phosphate levels remained same in all three groups at each visit, p-value > 0.05. At 3rd month the mean Vitamin D levels were significantly higher in group B in comparison to group A & group C, p-value < 0.005 while group-A and group-C had statistically comparable Vitamin D levels, p-value > 0.05. The mean Thacher Score at last visit was 0.28±1.25 in group-A, 0.48±1.34 in group-B and 0.81±1.55 in group-C,

Conclusion: Through the findings of this study, it is concluded that radiological healing was equal in injectable and oral groups. Vitamin D level was higher in injectable group compared to oral group in our study.

Keywords: Children, Rickets, Serum 25(OH)D,Thacher Score


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