This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Pediatrics
[{'content': 'In Rickets seen – \nSelect and explain. \nA. ↑ALP, B. Hypo PO4-2 in blood, C. Hyperphosphaturia, D. All of these', 'role': 'user'}, {'content': 'Answer: D \nExplanation: Serum markers of rickets\xa0\n\nDepending on the type of rickets following changes are seen in serum markers -\n\t1. Vit I deficiency or calcium deficiency\n\n\nVit D enhances absorption of Ca" from gut, So its deficiency results in decreased absorption.\nInitially serum Vit D level is maintained because of increased activity of parathyroid gland in response to calcium deficit. After some times, even the compensatory increase in parathormone cannot sustain normal calcium level —>L calcium.\nParatholluone also enhances renal excretion of phosphate Posphaturia -3 serum phosphate.\nBecause of unavailability of calcium and phosphate, bone mineralization is decrease --> compensatory increase in osteoblastic activity --> Increase alkaline phosphatase.\nSo, there is\n\ni) Normal to decreased calcium\nii)\xa0\xa0 Decreased phosphate (except in renal osteodystrophy, where phosphate level is increased because kidney is not able to excrete calcium).\niii) Increased parathormone\niv) Increased alkaline phosphatase \n2. Hypophosphatemic Rickets\n\nThis is due to deficiency of phosphate Decreased phosphate.\nCalcium level is normal.\nAs there is no calcium deficiency, there is no compensatory hyperparathyroidism ->\xa0Normal paratlzornzone.\nDue to unavailability of phosphate, mineralization of bone is decreased and there is increase in compensatory\n\nosteoblastic activity\xa0\xa0\xa0\xa0->\xa0\xa0 \xa0Alkaline phosphatase', 'role': 'assistant'}]