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A 10-year-old boy is brought to the physician because of
weakness and decreased appetite for 3 months. He weighs 30 kg (66 lb) and is
142 cm (56 in) tall; he has had a 2.3-kg (5-lb) weight loss since his
last examination 6 months ago. He appears thin. Deep tendon reflexes
are brisk. Chvostek's sign is positive. His serum calcium level is 6.5
mg/dL, and serum intact parathyroid hormone level is 190 pg/mL
(N=9“65). In addition to calcium supplementation, which of the following is
the most appropriate next step in management?

A
) Oral phosphate supplementation

B
) Oral vitamin D supplementation

C
) Intranasal calcitonin therapy

D
) Parenteral bisphosphate therapy

E
) Parenteral parathyroid hormone therapy

D?

vit D i mean

def ans B = hypocalcemia even w/ incr PTH levels

nila or anyone else is bishposphate used in primary hyperparatyroidsm to replace the low Phospahte levels??

dont you think A should be the answer?

this is a case of secondary hyperparathyroidism,inresponse to low calcium because of calcium def.In primary ca is high,pos is low.
i mean cal. was low bec of vit d def.so parathyroid got stimulated
nila is correct