TREATMENT OF SALT-WASTING CAH IN INFANCY

TREATMENT OF SALT-WASTING CAH IN INFANCY
QUESTION
-I would like to know if it is OK to use regular table salt as supplement in salt losing CAH , during early infancy. Sirisha Kusuma sirisuma@gmail.com Rainbow Children's Hospital, Hyderabad
RESPONSE-Yes.Tthe usual dose is 1 gram daily for a salt waster with CAH. You can put in the milk if the baby is being bottle fed and put 0.2 gms in each feed. If the baby is breast fed you dissolve it in water and distribute it over the day giving 0.2 gms every 5 hrs.  I should really like to speak to the doctor caring for the baby- my office is 212 241 7847.  Maria New, MD Mount Sinai School of Medicine New York

INFLAMMATORY BOWEL DISEASE AND OSTEOPOROSIS- RISK AND TESTING

QUESTION (1): WE in the gastroenterology clinic treat patients with IBD. Inflammatory conditions are a risk factor for osteoporosis. Do you recommend a DEXA scan for this group of patients ?
RESPONSE-The National Osteoporosis Foundation recommends  the following.
Since IBD is a risk factor, it is reasonable that this would justify testing in these patients.
BMD testing should be performed.....
–In women age 65 and older and men age 70 and older.
–In postmenopausal women and men above age 50–69, based on risk factor profile.
–In postmenopausal women and men age 50 and older who have had an adult age fracture, to diagnose and determine degree of osteoporosis.
–At dual x-ray absorptiometry (DXA) facilities using accepted quality assurance measures.
QUESTION (2)  How often do you  recommend  monitoring vitamin D levels, once corrected ?
Stein Assaf, MD,  Meir Medical Center, Kfar Sava, Israel
RESPONSE-It depends on clinical circumstances. It takes at least 3 months to reach a steady state after starting or changing vitamin D supplementation, so it is best to wait at least 3 months to determine whether the treatment goal has been achieved. Once that has occurred, then I would check it no more often than once a year, provided there is no reason to believe that vitamin D level has changed.   E Michael Leweicki, MD