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You are the paediatric registrar at an epilepsy clinic. A mother of a 9-year-old patient with childhood absence epilepsy asks if he should be taking vitamin D. He is currently prescribed sodium valproate. You wonder if you should prescribe vitamin D supplementation alongside his antiepileptic medication. In children with a clinical diagnosis of epilepsy on antiepileptic drugs (AED) (population), is there evidence to suggest that they should receive supplemental vitamin D (intervention) to improve their bone health (outcome)? We searched OVID MEDLINE in June 2020 with the keywords (Child OR Paediatrics OR Pediatrics) AND (Vitamin D OR Vitamin D Deficiency OR Cholecalciferol OR Calcitriol) AND (Anti-Epileptic Drug OR Anti-Epileptic Medication OR Anti-Convulsant Drug). The search was limited to articles in English from the year 2000. Sixty-five articles were identified. Twenty articles were included after initial scrutiny and four were selected for full-text review. One further study was identified on review of article references. These were graded according to the Oxford level of evidence (table 1).1 View this table: Table 1 Summary of included studies Vitamin D deficiency is common worldwide. Vitamin D is protective for musculoskeletal health. Children treated with AED are known to have problems with bone metabolism and bone mineral density (BMD) loss. Enzyme-inducing AEDs (phenytoin, carbamazepine, primidone and phenytoin) increase vitamin D metabolism due to induction of cytochrome P450. Newer, non-enzyme-inducing antiepileptic drugs (NEIAEDs) can affect bone metabolism in a variety of ways, including stimulation of osteoclast activity, direct action on bone cells, parathyroid hormone resistance, inhibition of calcitonin secretion …

Acute kidney injury (AKI) is under-recognised in children and neonates. It is associated with increased mortality and morbidity along with an increased incidence of chronic kidney disease in adulthood. It is important that paediatricians are able to recognise AKI quickly, enabling prompt treatment of reversible causes. In this article, we demonstrate an approach to recognising paediatric AKI, cessation of nephrotoxic medication, appropriate investigations and the importance of accurately assessing fluid status. The mainstay of treatment is attempting to mimic the kidneys ability to provide electrolyte and fluid homeostasis; this requires close observation and careful fluid management. We discuss referral to paediatric nephrology and the importance of long-term follow-up. We present an approach to AKI through case-presentation.