A 2-year-old child presents with bowing of legs, widened wrists with cupping and fraying on X-ray, and a serum calcium of 8.0 mg/dL, phosphate 2.5 mg/dL, alkaline phosphatase 600 IU/L, and 25-OH Vitamin D level of 8 ng/mL. The MOST appropriate treatment is:
- A Cholecalciferol 600,000 IU stoss dose intramuscularly and calcium supplementation ✓
- B Calcitriol (1,25-OH2D) 0.25 mcg daily
- C Calcium supplementation alone 500 mg/day
- D Oral cholecalciferol 1000 IU/day for 3 months
Correct answer: A. Cholecalciferol 600,000 IU stoss dose intramuscularly and calcium supplementation
Explanation
This presentation is classical nutritional rickets with confirmed vitamin D deficiency (25-OH D < 10 ng/mL) in a toddler. For symptomatic rickets with skeletal deformities and biochemical evidence, stoss therapy (single oral or IM dose of 600,000 IU cholecalciferol) with calcium supplementation is widely used in India to ensure rapid correction and compliance. Daily low-dose therapy (1000 IU) is appropriate for prevention or mild deficiency. Calcitriol is reserved for renal rickets or 1-alpha-hydroxylase deficiency.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.