Abstract
ABSTRACT: 
 BACKGROUND & OBJECTIVE: Rickets is a common presentation on the pediatric floor, with nutritional rickets being the cause of leading significant morbidity, disability, especially in the developing countries of the world. The objective is to compare the efficacy of parenteral and oral vitamin D supplementation in the treatment of nutritional rickets
 METHODOLOGY: This comparative interventional, prospective analysis was conducted at Aziz Fatimah Hospital Faisalabad (1-1-2017 to 30-6-2017) outdoor patients divided into parenteral and oral groups. All of the outcome variables were measured at baseline and one month after treatment.
 RESULTS: In this study, mean age was calculated as 2.12 + 0.76 years and 2.15+0.77 in parental and oral groups respectively. 49.29% (n=69) and 45%(n=63) were male and 50.71%(n=71) and 55% (n=77) were female respectively in both groups. At baseline, serum calcium was 8.68 + 0.35 and 8.71 + 0.37 (p=0.62) serum phosphorus was 3.92 + 9.22 and 3.84 + 0.20 (p=0.03), and serum alkaline phosphatase was 230.01 + 13.09 and 228.89 + 13.80 (p=0.48) in parenteral and oral groups respectively. After treatment the mean change seen in serum calcium was 1.14 + 0.26 and 0.72 + 0.19 (p=0.001), serum phosphorus was 1.42 + 0.33 and 0.71 + 0.26 (p=0.001), serum Alkaline phosphatase was 79.48 + 14.84 and 23.65 + 12.21 (p=0.001) in parenteral and oral groups respectively.
 CONCLUSION: We concluded that the parenteral route for vitamin. D supplementation is significantly better than the oral route in treating nutritional rickets in terms of mean change in serum calcium, serum phosphorus, and serum alkaline phosphatase.
Highlights
Rickets is defined as the failure to mineralize growing bones before the closure of growth plate in children [1]
[10] The objective of this study was to compare singledose I/M vitamin D with daily dose oral vitamin D supplementationas a part of nutritional rickets management to see meaningfulchange in serum calcium, phosphorus and alkaline phosphatase, and based on the findings, patients can be provided with better treatment options and morbidity can be reduced
Rickets is a common presentation on the pediatric floor with nutritional rickets, leading to significant morbidity and even disability, especially in the world's developing countries
Summary
Rickets is defined as the failure to mineralize growing bones before the closure of growth plate in children [1] It is caused by vitamin D, calcium and phosphorus deficiency. In a study conducted in Egypt, children with rickets were treated with oral and intramuscular vitamin D supplements with a mean change in serum calcium of 0.78+0.98 and 1.23+1.61(p=0.56) respectively and mean decrease in serum alkaline phosphates. After treatment the mean change seen in serum calcium was 1.14+0.26 and 0.72+0.19 (p=0.001), serum phosphorus was 1.42+0.33 and 0.71 +0.26 (p=0.001), serum Alkaline phosphatase was 79.48 +14.84 and 23.65+12.21 (p=0.001) in parenteral and oral groups respectively. D supplementation is significantly better than the oral route in treating nutritional rickets in terms of mean change in serum calcium, serum phosphorus, and serum alkaline phosphatase.
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