Q: A 5 month old baby with very poor general condition, proctosis, ricketic rosary and inguino-scrotal swelling (right sided). Is it a simple case of rickets? We have already given 6 lac units of Vit.D. Is there any further treatment required? Or any other investigations apart from X-ray wrist joint, serum calcium, Alkaline phosphotase and phosphate?

A:This 5 month old child may have Renal Tubular acidosis as being responsible for his poor general condition, so please get 2 or three urine samples for pH in the early morning. A routine urine to rule out tubular dysfunction in the form of glycosuria or Proteinuria would also be useful along with a urine specific gravity to check the concentrating ability of the kidney. Also get a venous blood gas, Blood urea, creatinine and a liver function test to rule out an underlying hepatic problem. It shall be a good idea to supplement the baby with oral calcium and give the calcium to the mother too if she is breast feeding. The message was a little unclear - does the child have proptosis or proctosis, and an Inguinal Hernia. Also what is the cause of malnutrition? Rule out a urinary tract infection.