Clinical assessment | Right Decisions

Right Decisions
SPEG (Scottish Paediatric Endocrine Group)
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Management of nutritional Vitamin D deficiency in children and adolescents
Clinical assessment

Please update your RDS mobile app to version 4.7.1

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

History and examination

Dietary history from birth.
Exposure to sunlight (child and mother).
Use of drugs and multivitamins.
Motor development.
Measure and accurately plot height and weight.
Assess general nutritional status.
Look for classical signs of rickets.

Investigations

Left wrist X-ray in children <3 years old, knee X-ray in children >3 years old.
Serum urea, electrolytes, creatinine.
Bone profile (Ca, Mg, Phosphate, Alkaline Phosphatase).
Liver function tests.
Full blood count.
PTH.
25 Hydroxy Vitamin D.

Diagnosis

The classical biochemical picture of vitamin D deficiency is:

Calcium – Normal or low.
Phosphate – Normal or low.
Alkaline phosphatase – Raised.
PTH – Normal or raised.
25 Hydroxy cholecalciferol (25OHCC) – Low.

Vitamin D serum concentrations

Deficiency – Less than 30nmol/L.
Insufficiency – 30 to 50nmol/L.
Sufficiency – Above 50nmol/L.