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Vitamin D deficiency presenting to an emergency department of a children's hospital: a growing concern
  1. L Kehler1,
  2. S Verma1,
  3. R Krone1,
  4. E Roper2
  1. 1Emergency Department, Birmingham Children's Hospital, Birmingham, UK
  2. 2Chase Terrace Technology College, Burntwood, UK

Abstract

Aim The last few years have seen a concerning trend with a rise in the numbers of children who are diagnosed with Vitamin D deficiency in the UK. We aimed to provide further information about this trend.

Methods A retrospective survey of children who were diagnosed with Vitamin D deficiency in the emergency department between March 2009 and March 2010. We then looked for trends in the other biochemical results obtained at that time, the children's presenting complaint and their ethnic origin.

Results There were 89 children who were diagnosed during the study period with Vitamin D deficiency (<50 nmol/litre). Severe deficiency (<25 nmol/litre) was noted in 83% of these.

Presentation: The most common presenting complaints were abdominal pain (19%), seizures (17%) and limb pain (15%). Many children were picked up due to raised alkaline phosphatase after non specific presentations.

Ethnic Origin: The results for ethnic origin were based on documentation in the computerised hospital records. Asian British Pakistani represented 37%, the greatest proportion of the total.

Biochemistry: Hypocalcaemia was noted in 10% of the Vitamin D deficient children. All of these had a vitamin D level less than 25 nmol/litre. Their ages showed a bimodal distribution predominantly affecting the under 1's and the over 12's. Parathyroid hormone was measured in 50 children. All children with a vitamin D level <5 nmol/litre had raised levels of PTH. The PTH was measured in 33 children with a Vitamin D level between 5-25 nmol/litre. A raised level detected in 29 of them (88%).

Conclusions Our data adds further evidence to the wide scale problem of undiagnosed Vitamin D deficiency. It should be considered in non caucasian children, not only presenting with hypocalcaemic seizures or bone manifestations, but also in more non specific presentations such as abdominal pain. We feel the numbers detected represent the tip of the iceberg of the true prevalance of Vitamin D Deficiency. We propose legislation to fortify foods should be debated further on a national level.

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