Test |
Value |
S. Creatinine |
0.6 mg/dL |
S.Corrected Calcium |
7.9 mg/dL |
S. Phosphorus |
1.8 mg/dL |
25 (OH) Vit D |
12.7 ng/mL |
1,25 (OH) Vit D |
10 pg/mL |
Total Alkaline phosphatase (ALP) |
230 U/L |
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A- Interpret the above laboratory workup.
Vitamin D deficiency result in reduced intestinal absorption of calcium and phosphorus leads to
B- What is the most likely cause of the patient’s bone disease?
vitamin D deficiency
Causes of Vitamin D deficiency:
in this case she is at risk of vitamin D deficiency because she is confined indoors and her dietary vitamin D intake is low (strict vegetarian).
C- Suggest a management plan for this patient.
A- Interpret the above laboratory work-up.
Osteomalacia due to vit D deficiency causing hypocalcemia and Hypophosphatemia.
B- What is the most likely cause of the patient’s bone disease?
Decrease dairy products intake and less sun exposure.
C- Suggest a management plan for this patient.
A:VD deficiency lead to hypocalcemia and hypophosphatemia.
B:osteomalacia
C :VD supplementations plus calcium and phosphorus
sun exposure and good dietary intake
physiotherapy
A vitamin d deficiency due to lack of sun , diet( vegetarian)
B osteomalacia
C replete vitamin D levels , sun exposure , physical therapy and good dietary intake
A- Interpret the above laboratory work-up.hypocalcemia, hypophosphatemia,due hypovitaminosis d
What is the most likely cause of the patient’s bone disease?
the patients’ presentations are clearly defining the Osteomalacia due long standing of vitamin D deficiency.
Suggest a management plan for this patient.
I would suggest this patient take a vitamin D supplement (1000IU daily ) with calcium.
Adequate sun exposure.
Vitamin D-rich diet
Vitamin D deficiency mostly is the cause of both hypocalcemia and hypophosphatemia. All of these abnormalities are the main reason for the patient presentation. Being a strict vegetarian especially with lack of sun exposure leads to severe vitamin D deficiency and mineralization defects. Alkaline phosphatase is a bone formation marker that typically increases in case of osteomalacia as the osteoblasts are actively laying out collagen to compensate for the bone softening and the mineralization defect.
B. What is the most likely cause of the patient’s bone disease?
Osteomalacia is characterised by defective bone mineralization that results from hypophosphatemia, hypocalcemia and vitamin D deficiency. The patient presents clinically by bone aches and low or non-trauma fractures. The most common radiologic findings are thinning of the cortical bone and bowing of long bones.
C. Suggest a management plan for this patient.
The main line of treatment in this case is management of vitamin D deficiency together with calcium and phosphorus supplementation. adequate sun exposure, physical therapy and good dietary intake is recommended. For individuals with serum vitamin D levels of 12 to 20 ng/mL, initial supplementation with 800 to 1000 international units (20 to 25 micrograms) daily may be sufficient. A repeat serum 25(OH)D level should be obtained after approximately three months of therapy to assure obtaining the goal serum 25(OH)D level. If goal level is not achieved, higher doses may be necessary.
A- Interpret the above laboratory work-up.Hypocalcemia
hypophosphatemia
low vit D3
high ALP
What is the most likely cause of the patient’s bone disease?Osteomalasia due to vitamin D deficiency
Suggest a management plan for this patient.Supplementation with ca and p
adequate sun exposure
exercise
diet rich with vitamin D
vitamin D 1000iu dialy
A. Vitamin D deficiency, low calcium and phosphorus
B. Osteomalacia typically present with hypophosphatemia, hypocalcemia due to low nutritional vitamin d. There is some increased bone turnover trying to beak up bones to try to normalize calcium level , so AP is high as a marker of turnover.
C. Cholecalciferol 50000 weekly for 8 week than monthly.
Test Vitamin D level monthly
Sun exposure.
Diet with high phosphat and calcium
labd indicate Vitamin D deficiency, hypocalcemia, , and high alkaline phosphatase.
mostly due to Vitamin D deficiency/ Osteomalacia due to no sun exposure
C- Suggest a management plan for this patient.
Diet review
sun exposure from 7 am to 1 pm
A- low ca , phos and bit d
b- osteomalacia
c – sun exposure and dite+ vit d
A- Interpret the above laboratory work-up.
B- What is the most likely cause of the patient’s bone disease?
C- Suggest a management plan for this patient.
A- Interpret the above laboratory work-up.
B- What is the most likely cause of the patient’s bone disease?
C- Suggest a management plan for this patient.
A- Interpret the above laboratory work-up.
Patient has hypocalcemia, hypovitaminosis D, hypophosphatemia,
B- What is the most likely cause of the patient’s bone disease?
Patient has typical Osteomalacia
C- Suggest a management plan for this patient.
*Ca supplements
*PO4 supplements
*Vit D supplements
*Follow-up
Great! Adequate sun exposure, physical therapy and good dietary intake are also recommended.
Bowing of the bone, hypocalcemia, hypophosphatemia, and decreased vitamin D are consistent with osteomalacia, which can be explained by vitamin D deficiency. For that reason, we need to supplement the vitamin D treatment doses. Cholecalciferol (vitamin D3) is preferred. Can be 50.000 units weekly for 8 weeks, followed by a maintenance dose. There are many suggestions and options slightly different among societies
Right! however, for individuals with serum vitamin D levels of 12 to 20 ng/mL, initial supplementation with 800 to 1000 international units (20 to 25 micrograms) daily may be sufficient.
A- Interpret the above laboratory work-up.
A Hypocalcemia, hypophosphatemia, low vit D
elevated alkaline phosphatase , normal creatinine
B- What is the most likely cause of the
patient’s bone disease?
Osteomalacia secondary to Vitamin d deficiency due to vegetarian diet
low Ca .low Pi
C- Suggest a management plan for this patient.
vit D , Ca , pi supplementation
Adequate sun exposure, physical therapy and good dietary intake are also recommended
A- Interpret the above laboratory work-up.
Low calcium, phosphorous, low vitamin D level and store, normal s. Creatinine, increase alkaline phosphotase
B- What is the most likely cause of the patient’s bone disease?
Osteomalacia due to vitamin D deficiency causing decrease mineralization
C- Suggest a management plan for this patient.
Treatment with calcium supplement, vitamin D calcitriol, encourage sun exposure, diet contains vitamin D, exercise
Thanks! for individuals with serum vitamin D levels of 12 to 20 ng/mL, initial supplementation with 800 to 1000 international units (20 to 25 micrograms) daily may be sufficient.
A- Interpret the above laboratory work-up.
Hypercalcimia, hypophosphatemia, hypovitaminosis d elevated alkaline phosphatase
B- What is the most likely cause of the
patient’s bone disease?
Osteomalacia secondary to Vitamin d deficiency dueto vegetarian diet
C- Suggest a management plan for this patient.
Need pth level assessment
Correct hypocalcimia
Hypophosphatemia
Vit d replacement
Proper diet and sun exposure
Initial supplementation with 800 to 1000 international units (20 to 25 micrograms) daily may be required.
A- Interpret the above laboratory work-up.PATIENT HAS FRACTURE ALL LABS ARE GOING WITH SEVERE OSTEOPOROSIS WITH VERY LOW VIT D , CALCIUM AND PHOSPHOROUS , ELEVATED ALKALAINE PHOSPHATASE
B- What is the most likely cause of the patient’s bone disease?THE MOST LIKLY CAUSE IS HER LIFE STYLE ( POOR DIET AND NO SUN EXPOSURE )
C- Suggest a management plan for this patient.
CORRECTION FOR HYPOCALCEMIA , HYPOPHOSPHATEMIA AND VIT D DEF.
WITH ORAL CALCIUM ,VIT D , PHOSPHOROUS CORRECTION ,GOOD DIET AND SUN EXPOSURE
This is defective mineralization (osteomalacia) rather than osteoporosis.
Interpret the above laboratory work-up.This patient is having hypocalcemia and hypophosphatemia with a very low VIt D level
she is vegetarian and does not have enough exposure to sunlight so this patient has osteomalacia
What is the most likely cause of the patient’s bone disease osteomalacia
Suggest a management plan for this patient.
This lady needs to start on oral Vitd D supplements ASAP with 800 to 1000iu daily dose
need to encourage for sun exposure and good dietary intake.
Need to check PTH and to do DEX scan both will help us in differentiating the type of bone problems this lady has .
Great! A repeat serum 25(OH)D level should be obtained after approximately three months of therapy to assure obtaining the goal serum 25(OH)D level. If goal level is not achieved, higher doses may be necessary.
A- Interpret the above laboratory work-up.Normal serum creatinine, ,hypophosphatemia, hypocalcemia , vitamin d deficiency with high serum alkaline phosphatase
B- What is the most likely cause of the patient’s bone disease?Osteomalacia secondary to Vitamin d deficiency
C- Suggest a management plan for this patient.
A repeat serum 25(OH)D level should be obtained after approximately three months of therapy to assure obtaining the goal serum 25(OH)D level. If goal level is not achieved, higher doses may be necessary
normal serum creatinine, hypocalcemia,hypophosphatemia, vitamin d deficiency with high serum alkaline phosphatase
osteomalacia secondary to Vitamin d deficiency
Treatment of vitamin d,calcium and phosphate supplement
consider animal product rich in vitamin d
sun exposure
With serum vitamin D levels of 12 to 20 ng/mL, initial supplementation with 800 to 1000 international units (20 to 25 micrograms) daily may be sufficient. A repeat serum 25(OH)D level should be obtained after approximately three months of therapy to assure obtaining the goal serum 25(OH)D level. If goal level is not achieved, higher doses may be necessary
A- Interpret the above laboratory work-up. Labs consistent with deficiency type of osteomalacia
B- What is the most likely cause of the patient’s bone disease? Vegan diet
lack of sun exposure
C- Suggest a management plan for this patient. Encourage patient to change her dietary habits and to increase sun exposure
oral calcium intake
vit D supplementation .
The treatment should include calcium and phosphorus supplementation. adequate sun exposure, physical therapy and good dietary intake. For individuals with serum vitamin D levels of 12 to 20 ng/mL, initial supplementation with 800 to 1000 international units (20 to 25 micrograms) daily may be needed.
A- Interpret the above laboratory work-up.
the laboratory finding show
hypocalcemia
hypophosphatemia
hypovit25 (oH) vit.D
hypo active 1-25 (oh) vit. D
the impression of these finding deficiency type of osteomalacia
B- What is the most likely cause of the patient’s bone disease?
elderly pt.
malnutritional status
no sun exposure
deficiency of calcium intake
deficiency of vit.D
Phosphorus deficiency
C- Suggest a management plan for this patient.
control and supplement of all deficiency
vit. D and calcium and phosphorus
and follow up all these lab. again
bone imaging x-ray and dexa scan
Great! Vitamin D supplementation should be considered in individuals with serum vitamin D levels of 12 to 20 ng/mL.
the pt has hypocalcemia, hypophosphatemia, normal serum creatinine, low 25(oh) vit d, subsequently low calcitrol, and normal kfts, pointing to nutritional osteomalacia.
What is the most likely cause of the patient’s bone disease? nutritional vit D deficiency due to
1- inadequete sun exposure
2- inadequete diet
Suggest a management plan for this patientas the patient has no evidence of liver or kidney diseases, the activation of vit D will go smooth
1- vit d2 50,000 IU/ wk for 8 weeks, then followed by vit d3 1000 IU/day
2- calcium supplementation, as calcium carbonate 1000mg/day
3- phosphate supplementation
A- Interpret the above laboratory work-up.
B- What is the most likely cause of the patient’s bone disease?
C- Suggest a management plan for this patient.
A- Interpret the above laboratory work-up.
Hypocalcemia-Hypophosphatemia-low vitamin D and High ALP
B- What is the most likely cause of the patient’s bone disease?
Osteomalacia which is unmineralized bone due to a lack of calcium, phosphate and vitamin D, is usually caused by nutritional deficiencies or diminished absorptive capacity
C- Suggest a management plan for this patient.
Nutritional supplements such as a diet rich in calcium and vitamin D
Vitamin D supplementation and encourage the patient to expose to the sun
A- hypocalcemia , hypophosphatemia with vit D deficiency with normal serum creatinine
B- osteoporosis due to vit D deficiency related to decreased sun exposure
C- 1- increased sun exposure
2- calcium supplementation either with drugs or diet
3- IV cholecalciferol until vit D levels improve and relief of symptoms
Interpret the above laboratory workup.Normal kidney function with severe vitamin deficiency, hypocalcemia, and hypophosphatemia.
What is the most likely cause of the patient’s bone disease?As the patient is vegetarian and home-bound the most likely diagnosis is nutritional vitamin D deficiency rickets.
Possible underline cause
a) Type 1 is due to 1 alpha-hydroxylase deficiency.
b) Type 2 is due to a mutation in the vitamin D receptors.
Suggest a management plan for this patient.
A- Interpret the above laboratory work-upPATIENT HAS NORMAL KFT ( VERY LOW S.CREATININE MAY INDICAT MALNUTRITION ) , HE HAS HYPOCALCEMIA HYPOPHOSPHATEMIA HIGH ALK. PHOSPH. WITH VERY LOW VIT D
B- What is the most likely cause of the patient’s bone disease?
MOSTLIKLY HE HAS OSTEMALCIA
MOSTLIKLY CAUSE IS VITAMIN D DFE. AND POOR DIET
C- Suggest a management plan for this patient.
SUN EXPOSURE , DIET AND VIT D WITH CALCIUM
A- Interpret the above laboratory workup.
hypocalcemia, hypophosphatemia, and increased serum alkaline phosphatase level are the classic biochemical triad of osteomalacia and increased serum alkaline phosphatase level is the most frequent and the earliest biochemical manifestation.
B- What is the most likely cause of the patient’s bone disease?
A vegan diet and lack of exposure to the sun lead to vitamin D deficiency
and as a result, the patient has nutritional osteomalacia.
The lab findings in osteomalacia are hypophosphatemia, hypocalcemia, low levels of 25-hydroxyvitamin D (25[OH]D), and increased parathyroid hormone (PTH) and alkaline phosphatase levels.
C- Suggest a management plan for this patient.
The cause determines osteomalacia treatment.
change diet habits and exposure to the sun
correction of hypophosphatemia, hypocalcemia, and vitamin D deficiency.
Vitamin D deficit: Vitamin D replacement improves muscular strength and bone pain in individuals with severe vitamin D insufficiency. Many doctors treat nutritional deficiency (25[OH]D <12 ng/mL [30 nmol/L]) with 50,000 international units of vitamin D2 or D3 orally once a week for six to eight weeks, followed by a maintenance dosage.
In addition to vitamin D supplementation, all patients should maintain a calcium intake of at least 1000 mg per day since an inadequate intake of calcium may contribute to the development of osteomalacia.
For individuals with serum vitamin D levels of 12 to 20 ng/mL, initial supplementation with 800 to 1000 international units (20 to 25 micrograms) daily may be sufficient.