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例1:女,1岁2月,因哭闹不安,食欲减退,四肢少动20天来诊。体检:营养发育欠佳,精神萎靡,烦躁,轻度贫血貌,头发稀疏,枕部脱发环,前囟2.0cm×2.5cm,平,双颞部稍隆起,轻度鸡胸,肋外翻。心肺听诊正常。腹稍大软,肝肋下2cm,脾未及,四肢被动活动有压痛。实验室检查:血红蛋白85g/L,白细胞11.4×10~9/L,中性0.42,淋巴0.58;血钙2.5 mmol/L、磷1.9mmol/L、碱性磷酸酶3.4235μmol·s~(-1)/L。X线摄片四肢长骨见骨膜反应,长骨骺密度减低,呈毛玻璃样改变,拟诊佝偻病(激期),轻度贫血。按佝偻病治疗,症状加重。仔细询问病史,患儿6月龄始添加浓鱼肝油滴剂。初每日2次,每次5滴,至入院前2个月增至每次15～20滴,每日2次。即停服浓鱼肝油滴剂,对症处理,3天后症状明显好转。2周后X线摄片两下肢骨膜反应
Example 1: Female, 1 year old in February, due to crying and restlessness, loss of appetite, limbs less 20 days to visit. Physical examination: poor nutrition, apathetic, irritability, mild anemia appearance, thinning hair, occipital hair loss ring, bregma 2.0cm × 2.5cm, flat, double temporal slightly bulging, mild chicken breast, rib valgus. Cardiopulmonary auscultation normal. Slightly big soft belly, liver ribs 2cm, spleen, passive limbs have tenderness. Laboratory tests showed that hemoglobin 85g / L, leucocyte 11.4 × 10-9 / L, neutrality 0.42, lymphoid 0.58, serum calcium 2.5 mmol / L, phosphorus 1.9mmol / L, alkaline phosphatase 3.4235μmol · s -1 ) / L. X ray long limbs see the periosteal reaction, the long epiphyseal density decreased, was frosted glass-like changes, the proposed diagnosis of rickets (agitation), mild anemia. According to rickets treatment, the symptoms worsened. Carefully ask history, children 6 months old to add concentrated fish liver oil drops. 2 times a day, 5 drops each time, to 2 months before admission increased to 15 to 20 drops each time, 2 times a day. Stop taking concentrated cod liver oil drops, symptomatic treatment, 3 days after the symptoms improved significantly. Two weeks after radiography two lower extremity periosteal reaction