What dose of Vitamin D₃ is recommended in the treatment protocol of nutritional Rickets?

Appeared in: NIA - 29 January 2023

Explanation

The regimen of 60,000 IU of Vitamin D₃ daily for 10 days is a standard 'stoss therapy' for nutritional rickets.
This protocol delivers a total dose of 600,000 IU, which is effective for rapidly replenishing vitamin D stores and initiating bone healing.
This intensive initial therapy is followed by a lower daily maintenance dose to prevent recurrence.
Concurrent administration of calcium is essential during treatment to prevent 'hungry bone syndrome,' a condition where rapid bone mineralization leads to severe hypocalcemia.

Option B: A total dose of 60,000 IU (6,000 IU/day for 10 days) is insufficient for the initial, intensive treatment of established nutritional rickets.
Option C: Administering 600,000 IU daily for 10 days results in a total dose of 6,000,000 IU, which is dangerously high and can lead to severe vitamin D toxicity and life-threatening hypercalcemia.
Option D: This option is incorrect because a valid and recommended treatment protocol is provided in the options.

Clinical Relevance

Nursing practice connection: Knowing Pharmacological management of nutritional rickets helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Nurses play a critical role in educating caregivers about the importance of adhering to the prescribed Vitamin D and calcium regimen. Administering Vitamin D with a fatty meal can enhance absorption.
Monitoring is key. The nurse must assess for signs of improvement (e.g., decreased bone pain, improved muscle strength) and for adverse effects, including symptoms of hypocalcemia (tetany, muscle cramps) during healing or hypercalcemia (vomiting, polyuria, dehydration) from toxicity.
What if? If a child has a malabsorption syndrome (like celiac disease or cystic fibrosis), oral vitamin D may not be effectively absorbed. In such cases, higher oral doses or parenteral (intramuscular) administration may be necessary to achieve therapeutic levels.

How to Approach the Question

First, identify the core of the question, which is asking for the specific dosage of Vitamin D₃ for treating nutritional rickets.
Recall or look for standard pharmacological treatment protocols. Recognize that rickets requires a high initial dose to correct the deficiency rapidly.
Evaluate each option by calculating the total dose administered over the specified period.
Option A: 60,000 IU/day × 10 days = 600,000 IU total. This is a known 'stoss therapy' regimen.
Option B: 6,000 IU/day × 10 days = 60,000 IU total. This is too low for treatment.
Option C: 600,000 IU/day × 10 days = 6,000,000 IU total. This is a toxic dose.

Concept Tested & Keywords

QOCYgXQ82f0rsLXx8-8Cg9

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 104-106

Practise the full NIA - 29 January 2023

Attempt every question from this paper in a timed mock, then review the full solution for each one.