Q:

What investigations would be indicated in a case of rickets?

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An 8-year-old male presents with concern for bilateral genu valgum deformity and complaint of pain in both lower limbs on walking or running. Parents note that he has always been the shortest boy in his class at school and his complaints of pain on walking and lower limb deformity have developed and progressed over the past six months. Patient and parents deny any trauma, and there is no history of fractures. Patient does not have any alopecia, or dental problems such as discoloration or abscesses. Patient has a history of polyuria and primary nocturnal enuresis.

What investigations would be indicated in a case of rickets?

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• Radiologic investigations: X-ray with PA views of the wrist, knees, chest, ultrasound of kidney to assess for any nephrocalcinosis

• Lab investigations: Serum calcium, phosphorus, alkaline phosphatase, 25-hydroxy Vitamin D, PTH, 1,25–dihydroxy vitamin D, sodium, potassium, chloride, bicarbonate, anion gap, renal function (urea, creatinine)

– Urine—pH, urine calcium, urine creatinine, urine glucose, urine protein, urinary phosphorus.

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