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Severe nutritional rickets — RACP Paediatrics MCQ

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ModerateEndocrineSevere nutritional ricketsRACP Paediatrics

A 12-month-old exclusively breastfed infant from a refugee background has florid rickets with craniotabes and rachitic rosary. Serum calcium is critically low (1.4 mmol/L) and the child has a brief seizure. After IV calcium stabilisation, what is the ongoing management?

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Correct answer: E — Vitamin D and calcium supplementation

After acute management of hypocalcaemic seizures with IV calcium, ongoing treatment of nutritional rickets requires oral vitamin D supplementation (typically cholecalciferol 1000-5000 IU/day depending on severity) plus oral calcium. Monitoring of calcium, phosphate, ALP, and 25-OH vitamin D guides therapy duration. Maternal vitamin D supplementation is also important if breastfeeding continues.

Reference: RCH Melbourne – 2023 – Rickets CPG; RACP Paediatric Curriculum – Endocrine