Hot Seat #255: Denouement
Posted on: March 26, 2026, by : Brittany FitzpatrickThis week’s case highlights the challenging aspects of how much work-up should be done in an ED setting for issues that are not a part of the chief complaint (this case was fever and URI symptoms consistent with a viral etiology). We discussed how our some of our patient population has limited access to care, which might necessitate more work-up for “chronic” or outpatient issues that could have the potential to become acute such as hypocalcemia.
Patient was admitted to the hospital for management of acute hypocalcemia in the setting of rickets. Endocrine consulted: started on calcium, calcitriol, Vit D and labs stabilized. Ortho consulted with no casting due patient’s limited mobility and is non-ambulatory, recommended follow-up with PCP for OI work-up.
Nutrition and speech consulted and the patient received intensive therapies.
Discharged with close PCP and endo follow-up. He was briefly lost to follow-up. He was then seen by Endocrine who is currently recommending ongoing Vitamin D supplementation.
He has been making improvements in speech delay. At 2.5 year well child check he was ambulatory with a wide based gait, mild bowing of legs. No further information on whether OI work-up has been done.
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