Deep tendon reflexes

[Costa.]

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

Causes of Hyocalcemia & High PTH can be d/t
- Chronic Renal Failure
- Decreased Active Vit D levels via
> d/t Decr Intake or
-> Defective Metabolim seen in Vit D Dependent Rickets, Type I
-> Ineffective Vit D d/t Intestinal Malabsorption & Vit D Dependent Rickets Type II

So here most likely Rickets -> Give Ca & Vit D