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Jumpstart Toddlers 1996 Download4/21/2021
Kids build essential Kindergarten skills and get a head start on 1st Grade with the help of fun animal friends, music, and animation Master key skills in Math, Reading, Science, Spelling, and more.Qatar has a sunny hot weather allover the year with no seasonal variation in the incidence of rickets.
ElAlaily, Clinical Responses to a Mega-dose of Vitamin D3 in Infants and Toddlers With Vitamin D Deficiency Rickets, Journal of Tropical Pediatrics, Volume 56, Issue 1, February 2010, Pages 1926. Design: In this prospective study we evaluated the clinical, biochemical and radiological responses of an IM injection of cholecalciferol (10 000 IUkg) for 3 months. Results: At presentation, the most frequent manifestations were enlarged wrist joints, hypotonia, irritability, cranial bossing, wide anterior fontanel, bow legs, delayed teething and walking and Harrisons sulcus with chest rosaries. Short stature (length SDS 4 ) (75) and low calcium (Ca) (12.5). One month after treatment, serum Ca, PO 4 and 25(OH)D concentrations were normal. ![]() The majority of patients (87.5) had serum 25(OH)D level 20 ngml, but some (12.5) had level Conclusion: An IM injection of a mega dose of cholecalciferol is a safe and effective therapy for treatment of VDD rickets in infants and toddlers with normalization of all the biochemical parameters and healing of radiological manifestations. Measurement of serum 25(OH)D level is highly recommended in all short children with a clear need for a general vitamin D supplementation for all infants and young children in Qatar. The active form, 1,25-dihydroxyvitamin D markedly increases the efficiency of intestinal calcium and phosphorus absorption 15. Serum levels of 25-hydroxyvitamin D are directly related to bone mineral density with a maximum density achieved when the 25-hydroxyvitamin D level reached 40 ngml or more 6. Serum levels below 30 ngml are associated with a significant decrease in intestinal calcium absorption 5. In adolescents, children and adults; this is associated with increased parathyroid hormone 79. Parathyroid hormone enhances the tubular reabsorption of calcium and stimulates the kidneys to produce 1,25-dihydroxyvitamin D 14. Parathyroid hormone also activates osteoblasts, which stimulate the transformation of preosteoclasts into mature osteoclasts 13. ![]() However, the available evidence is not sufficient to support the use of bone mineral content or parathyroid hormone concentrations in infants and young children as functional outcomes to define deficient or sufficient levels of 25(OH)D. Children with vitamin D deficiency should be aggressively treated to prevent rickets 1, 1416. A cost-effective method of correcting vitamin D deficiency (VDD) and maintaining adequate levels is to give patients a large single dose of vitamin D, followed by a maintenance dose 2, 1416. In adults strategies such as having patients take 100 000 IU of vitamin D 3 once every 3 months have been shown to be effective in maintaining 25-hydroxyvitamin D levels at 20 ngml or higher and are also effective in reducing the risk of fracture 17. Higher doses of 100 000300 000 IU have been administered orally or intramuscularly 6-monthly or once-yearly quite safely without causing hypercalcemia or renal impairment. A Turkish study by Cesur et al. IU of vitamin D in 56 infants and toddlers with nutritional vitamin D rickets. The authors reported resolution of the disease process with all three doses, but six of the patients in the 600 000 IUdose group ( n 28) and two of the patients in the 300 000 IUdose group ( n 28) developed hypercalcemia, although none of these patients had symptoms of hypercalcemia. Therefore, the authors suggested that administering 150 000 IU of vitamin D might be sufficient to treat rickets 21. The effect of treatment using a single intramuscular mega-doses of vitamin D 3 on the clinical, biochemical and radiological manifestations of infantile rickets has not been well-studied. Intramuscular mega-dose of vitamin D was used in two studies both in children and adults (300 000 U and 600 000 U, respectively) with vitamin D deficiency and reported improvement of biochemical and radiological abnormalities 19, 20. The objective of this study was to evaluate the clinical, biochemical and radiological response to a single intramuscular large dose of vitamin D 3 (10 000 IUkg) in infants and toddlers presented with VDD rickets.
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