Author Question: Review Olivia's growth chart and identify the percentiles that correspond with her current ... (Read 19 times)

JMatthes · **on:** Aug 21, 2018

Review Olivia's growth chart and identify the percentiles that correspond with her current measurements. Describe the patient's growth velocity over the past year. How would you interpret this information?

What will be an ideal response?

Question 2

Briefly describe the process through which vitamin D deficiency impacts bone remodeling. Why is serum calcium level often normal in patients with vitamin D deficiency?

What will be an ideal response?

lcapri7 · **Reply #1 on:** Aug 21, 2018

Answer to Question 1

Height for age Olivia has been tracking along the 10th percentile for the past several years. Z-score for stature is -1.38.
Weight for age Olivia plots at the 1st percentile, down from the 5th percentile 2 years ago. Z-score for weight is -2.35 . BMI for age Olivia plots at the 2nd percentile, which is down from the 9th percentile 2 years ago. Z-score for BMI is -2.07
Using the McLaren method, the patient's IBW is 27.5 kg, indicating she is 84 of her IBW.
Weight velocity - At around age 8.5, Olivia's weight began to plateau. Over the past year, she has gained approximately 600g (0.6 kg), or an average of only 1.6 g/d. Her weight z-score has dropped from -1.8 to -2.35 and her BMI z-score has decreased from -1.5 to -2.07
This information should be interpreted as Olivia is not receiving adequate nourishment to obtain steady growth in body mass. This interpretation should acknowledge its limitations as these are compared against healthy children and may not accurately reflect Olivia's proper growth as a CP patient. CP patients may not acquire bone mass and skeletal muscle at the same rate as other children due to their limitations on weight-bearing activities.

Answer to Question 2

Vitamin D plays a role in bone remodeling by increasing the absorption of key minerals in bone formation such as calcium and phosphorus and by promoting the reabsorption of these minerals in the kidneys. Additionally, vitamin D will stimulate osteoclast formation, which will cause bone resorption (release of calcium and phosphorus from the bone into the serum).
Serum calcium levels are often normal in vitamin D deficient patients due to the body's tight regulatory control of serum calcium levels via the effects of parathyroid hormone, calcitonin, and vitamin D.