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Must know points about Vitamin-D and their Deficiencies

Must know points about Vitamin-D and their Deficiencies

Must know points about Vitamin-D and their Deficiencies

Rickets and osteomalacia are different expressions of the same disease , inadequate mineralization of bone .

The inadequacy may be due to defects anywhere along the metabolic pathway for vitamin D : nutritional lack , under exposure to sunlight, intestinal mal – absorption , decreased 25 – hydroxylation ( liver disease , anticonvulsant) and reduce 1alpha hydroxylation ( renal disease ) .

The following factors :

Decreased vitamin D  synthesis Due to chronic liver disease
Decreased nutritional intake of vitamin In strict vegetarian diet
Age and physiology related Elderly , obese , and institutionalised patients
Decreased maternal vitamin D stores Exclusive breast feeding
Malabsorption Celiac disease , pancreatic insufficiency (cystic fibrosis) , biliary obstruction (biliary atresia)
Increased degradation of  25 (OH) D3 Due to intake of drugs such as rifampicin , isoniazid ,anticonvulsant, glucocorticoids.

 

CLINICAL FEATURES OF RICKETS :

 The infants with rickets may present with tetany or convulsions. Later the parents may notice that there is a failure to thrive , listlessness and muscular flaccidity. Early bone changes are deformity of the skull (craniotabes ) and thinkening of the knees , ankles and wrists from physical overgrowth. Enlargement of the costochondral junctions ( Rickety Rosary) and lateral indentation of the chest ( Harrison’s sulcus ) may also appear.

Distal tibial blowing has been attributed to sitting or lying Cross – legged .

In active rickets there is thickening and Widening of the growth plate , cupping of the metaphysics and , sometimes , bowing of the diaphysis . The metaphysis may remain abnormally wide even after healing has occurred.

TREATMENT :

 Different methods of treating vitamin D deficiency have been advocated, ranging from small doses for a few months to a single mega dose , an approach referred to as Stoss therapy .

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