4.9 of 7 Ratings
A 70-year-old woman presents to the office for a yearly physical. She states she has recently started experiencing pain in her legs and her back. Last year, she experienced a fracture of her left arm while trying to lift groceries. The patient states that she does not consume any dairy and does not go outside often because of the pain in her legs and back. Of note, she takes carbamazepine for seizures. On exam, her vitals are within normal limits. You suspect the patient might have osteomalacia. Testing for which of the following is the next best step to confirm your suspicion?
Dietary vitamin D2
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A 2-year-old boy presents to the pediatrician for a well-child visit. The child has been doing well and this is his first visit to a pediatrician after being adopted. His parents state that he is doing well and wanted him to generally be checked out. His temperature is 97.0°F (36.1°C), blood pressure is 100/65 mm Hg, pulse is 100/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for the finding in Figure A. Laboratory values are ordered as seen below.Serum:Ca2+: 9.1 mg/dLPhosphorus: 1.1 mg/dLAlkaline phosphatase: 462 U/LParathyroid hormone: 23 pg/mL (N = 10-55)1,25-dihydroxyvitamin D: 22 pmol/L (N = 15-30)What is the most likely diagnosis?
Vitamin D deficiency rickets
Vitamin D resistant rickets
Type II vitamin D dependent rickets