PDF(Pubmed)
Abstract：
A 15-month-old African American male patient presented to the pediatric clinic to establish care. The patient had been seen and treated by a previous pediatrician who had diagnosed him with failure to thrive, anemia, and hepatosplenomegaly, according to the patient\'s parents. Upon physical examination, the patient was determined to be less than the first percentile for height and in the eighth percentile for weight. Frontal bossing was also observed. The patient\'s hemoglobin level was measured in the office to help confirm the previous anemia diagnosis and was determined to be 6.3 g/dL (normal: 10.5-13.0 g/dL). At this point, the patient was sent to a pediatric emergency department for continued treatment and workup. At the emergency department, the patient received an extensive laboratory workup for the evaluation of anemia, revealing iron deficiency anemia (hemoglobin: 5.6 g/dL (normal: 10.5-13 g/dL), mean corpuscular volume: 51.4 fl (normal: 70-84 fl), iron: 18 mcg/dL (normal: 30-70 mcg/dL), total iron binding capacity: 598 mcg/dL (normal: 100-400 mcg/dL), and hematocrit: 23.7% (normal: 33-38%)) and decreased levels of vitamin D (<6 ng/mL, normal: >30 ng/mL), ionized calcium (1.17 mg/dL, normal: 4.4-5.2 mg/dL), and phosphorus (2.4 mg/dL, normal: 2.9-5.9 mg/dL). These studies, paired with X-ray images of the patient\'s shoulders and wrists, further confirmed the diagnosis of rickets. Rickets is a disease in pediatric patients defined as a condition in which the mineralization of epiphyseal plates is defective. A nutritional deficiency in vitamin D, calcium, or phosphate causes acquired rickets. This condition is most commonly found in developing countries; some predisposing factors include poor sun exposure, high altitude, and breastfeeding. The patient was seen in the outpatient pediatric setting after the hospitalization, in which he received a blood transfusion, where he was managed on supplementation of calcium carbonate suspension, polysaccharide iron complex/novaferrum drops, and cholecalciferol drops with referral to endocrinology, hematology, and dietetics. This case serves as an example of how the diagnosis of nutritional deficiencies, such as rickets, can also be found in developed countries like the United States. Other conditions considered in the differential diagnosis were cystic fibrosis, necrotizing enterocolitis, metabolic disorders, inadequate absorption, and mechanical feeding difficulties, each of which must be ruled out to ensure that even an unlikely finding was not missed.
摘要：
一名15个月大的非裔美国男性患者前往儿科诊所建立护理。该患者曾被一位先前的儿科医生看过并治疗，该儿科医生诊断为无法茁壮成长，贫血,和肝脾肿大，根据病人的父母。在体检时,患者身高低于第一百分位数,体重低于第八百分位数.还观察到正面凹陷。在办公室测量患者的血红蛋白水平以帮助确认先前的贫血诊断，并确定为6.3g/dL（正常：10.5-13.0g/dL）。在这一点上,患者被送往儿科急诊科继续治疗和检查.在急诊室，患者接受了广泛的实验室检查以评估贫血，提示缺铁性贫血（血红蛋白：5.6g/dL（正常：10.5-13g/dL），平均红细胞体积：51.4fl（正常：70-84fl），铁：18mcg/dL（正常：30-70mcg/dL），总铁结合能力：598mcg/dL（正常：100-400mcg/dL），和血细胞比容：23.7％（正常：33-38％）和维生素D水平降低（<6ng/mL，正常：>30ng/mL），离子钙（1.17mg/dL，正常：4.4-5.2mg/dL），和磷（2.4毫克/分升，正常：2.9-5.9mg/dL）。这些研究,与患者的肩膀和手腕的X射线图像配对，进一步证实了病的诊断。Rick病是儿科患者的一种疾病，定义为骨phy板矿化有缺陷的疾病。维生素D的营养缺乏，钙，或磷酸盐会导致后天的病。这种情况最常见于发展中国家；一些诱发因素包括阳光照射不良，高海拔,和母乳喂养。患者住院后在门诊儿科就诊，他接受了输血，在那里他接受了碳酸钙悬浮液的补充，多糖铁络合物/novaferrum滴剂，和胆钙化醇滴剂，转诊至内分泌学，血液学,和营养学。这个案例是如何诊断营养缺乏的一个例子，比如病,在美国等发达国家也可以找到。鉴别诊断中考虑的其他疾病是囊性纤维化，坏死性小肠结肠炎,代谢紊乱，吸收不足,和机械进料困难，必须排除其中的每一个，以确保即使是不太可能的发现也不会错过。
