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Antacid-induced rickets in infancy
1Section of Pediatric Nephrology, Children's Mercy Hospital, University of Missouri at Kansas City, USA.
Insights
A premature infant developed rickets from high-dose antacids. Prompt treatment with phosphate and vitamin D resolved the condition, highlighting the risks of aluminum-based antacids in infants.
Area of Science:
- Pediatrics
- Biochemistry
- Pediatric Endocrinology
Background:
- Rickets is a condition causing bone softening in children.
- Premature infants are at higher risk for nutritional deficiencies and metabolic bone disease.
Observation:
- A 3-month-old premature infant presented with a soft skull, diagnosed as rickets.
- The infant had received high-dose aluminum-rich antacids for 5-6 weeks.
- Biochemical tests showed normal parathyroid hormone (PTH) and undetectable urine phosphate.
Findings:
- The clinical, radiologic, and biochemical presentation confirmed antacid-induced rickets.
- Normal serum PTH and hypophosphaturia are key indicators in infants.
- Hypocalciuria was observed, differing from hypercalciuria seen in adults.
Implications:
- Aluminum-containing antacids can rapidly induce rickets in premature infants.
- Pediatricians should limit the use of these antacids and monitor mineral metabolism.
- Early diagnosis and treatment with phosphate and vitamin D lead to rapid recovery.
Abstract:
A 3-month-old premature infant presented with a "soft skull." Clinical and radiologic findings confirmed the diagnosis of rickets. Biochemistry revealed normal serum parathyroid hormone (PTH) and undetectable urine phosphate. These findings combined with a history of 5-6 weeks' treatment with high-dose aluminum-rich antacid established the diagnosis of antacid-induced rickets. Discontinuation of the medicine combined with phosphate and vitamin D supplementation resulted in quick resolution of all clinical, radiologic, and biochemical abnormalities. Our patient demonstrates that in premature infants antacid-induced rickets can develop within a few weeks; normal serum PTH concentration and hypophosphaturia are highly indicative of the diagnosis, and contrary to the situation in adults in whom hypercalciuria has been often described, in infants hypocalciuria is more commonly observed. Pediatricians should avoid or minimize the use of aluminum-containing antacids, and when used, carefully monitor mineral metabolism.