Scope
This guideline is designed for use by paediatricians in secondary care and in the community.
Working Definition of Rickets
Raised Alkaline Phosphatase (ALP) and classic X-ray changes
Classic biochemical picture - Ca (↔/↓), P(↔/↓), ALP(↑), PTH (↔/↑), 25HCC (↓)
Vitamin D serum levels |
Deficiency <30 nmol/l Insufficiency 30-50 nmol/l Sufficiency >50 nmol/l |
Baseline Biochemical/Haematological Investigations
Serum - U&E’s, LFT, bone profile, FBC, Ferritin, PTH, Vitamin D
Summary of Suggested Treatment
Age |
Vit D (12 weeks)* |
Calcium 4 weeks** |
Single dose (STOSS) |
Maintenance |
<3 months |
2000units od1 |
none |
NA |
400u |
3-12months |
2000-2400units od2 |
500mg |
50 000units4 |
400u |
1-12years |
3000-6400units od3 |
500mg – 1000mg |
150 000units4 |
600u |
>12years |
6000–6400units od3 |
1000mg – 1500mg |
300 000units4 |
600u - 800u |
* range of doses given to allow for use of liquid and solid dose forms; see below
** if hypocalcaemic
1 – suggested formulation 10,000units/ml (e.g. Thorens)
2 – suggested formulations 10,000units/ml (e.g. Thorens) or 2,400units/ml (e.g. Invita D3)
3 – suggested formulation 10,000units/ml (e.g. Thorens)
4 – suggested formulations 25,000u/ml liquid, 20,000unit capsules or 25,000unit tablets