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A painful wrist & a toddling toddler

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Dipak Mistry Specialty Registrar in Emergency Medicine Homerton University Hospital, London E9 6SR

A 19 month old boy presented to an East London Emergency Department following a fall. He was unwilling to use his right hand and noted to be carried by his parents. He was a UK born Pakistani term child with no significant past medical history. Mum was a qualified doctor. On examination, he was reluctant to use his right wrist and noted to have an exaggerated toddling gait. Plain radiographs of the wrist showed cupped metaphyses typical of rickets. Diagnosis was confirmed with blood testing with total Vitamin D level of 20.4 ng/ml (replete >30), corrected calcium of 2.19 mmol/l (2.20-2.60) and a high alkaline phosphatase (ALP) of 1180 iu/L (30-390). Once considered to be a disease of the developing world and poverty, rickets is increasing in prevalence with migratory patterns and is crossing socioeconomic barriers. Education remains a cornerstone to prevention and treatment [1]. Scan for e-poster & to discuss

References 1. Pela I. How much vitamin D for children? Clin Cases Miner Bone Metab. 2012 May-Aug; 9(2): 112–117. Acknowledgements Snehal Sanghani


A painful wrist and a toddling toddler