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.