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Rickets of Vitamin D Deficiency
The Second Affiliated Hospital of Shantou University Medical College
Ma Lian
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Review
Rickets : signifying a failure in inernalization of growing bone or osteoid tissue.
Failure of mature bone to mineralize is called osteomalacia.
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Etiology Inadequate direct exposure to ultraviolet rays
in sunlight Inadequate intake of vitD (diet may contain litt
le vitD) Growth drug Disease:hepatic and renal lesions 、 celiac dis
ease 、 steatorrhea or cystic fibrosis
Or both
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About Vitamin-D Two forms : vitD2 /vitD3 vitD2 :most as irradiated ergosterol,largely r
eplaced the fish liver oils as source vitD3 :available in human skin as 7-dehydro
cholesterol. both are hydroxylated in the liver to 25 - (O
H)2D in the renal to 1. 25 - (OH)2D: facilitate calci
um and phosphorus absorpted
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Pathology
the epiphyseal plate of metaphysis is well demonstrated.
The cartilage cell is orderly
The calcified matrix forms the epiphyseal plate is regular
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The degenerating cartilage, islands of capillaries, osteoblasts, and unmineralized osteoid compose of broad , irregular, rachitic imtermediate zone
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Chemical pathology
can be conceptualized to be the body’s attempt to maintain normal serum calcium levels.
When calcium is lessparathormone is secretedincrease the calcium and phosphorus concentration
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Alkaline phosphatase (ALP). (normal level ≦200IU/dL) can be 500UI/dL. But may be normal in infants who have rickets and who are protein or zinc depleted.
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aminoaciduria, a decrease of citrate ,and its increased urinary excretion, decreased ability of the kidneys to make an acid urine, phosphaturia, and occasionally ,mellituria.
The parathyroid glands hypertrophy
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Clinical manifestations
Early signs:
Increased sweating, particularly around the head ,which result in the occipital bone bare
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Clinical manifestations
Advanced rickets: Head: early signs is cranio
tabes, Like a derby hat or
ping pong ball .
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Thorax:
rachitic rosary
Harrison’s groove
Pigen breast deformity
children are late in standing and walking
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The deformities of the long bones :knobbing and prominence of the epiphyses
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Other manifestations:
Teeth-erupting may be delayed,the enamel and extensive aries are defected.
Muscle tone is poor
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Roentgenographic findings
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Diagnosis
The diagnosis is based on: a history of inadeuate intake of vitamin
D and on clinical observation; then confirmed chemically ; by roentgenographic examination .
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Differential diagnosis
Scurvy: a ledgelike depression with the chondral or sternal portion is displaced below the osseous ribs.
Chondrodystrophy :irregular 、 concave outlines of the distal ends of the bones ,no roentgenographic evidence of fraying
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Other epiphyseal lesions: congenital epiphyseal dysplasia,cytomegalic inclusion isease ,syphilis ,rubella ,and copper deficiency.
Bowlegs :maybe a familial characteristic. Vitamin D-resistant rickets and other metab
olic disturbances with osseous lesions resembling rickets
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Complications
Respiratory infections :bronchitis and bronchopneumonia
pulmonary atelectasis Anemia due to iron deficiency or accom
panying infections
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Treatment
Natural and artificial light oral administration of vitD(preferred) d
aily administration:vitD3:50-150 µg or 1.25(OH)-D: 0.5-2 µg (except vitD refractory rickets
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Administering 15000 µg of vitamin D in a single dose without further therapy for several months may be advantageous. More rapid healing follows, possibly with earlier differential diagnosis from genetic vitamin D-resistant rickets .
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Roentgn-ray appearance showing healing
A: active rickets B: healing after 27 day:
new line of calcification
C: after 34 day calcification line dense;periosteal calcification increase
D: complete healing after 3 months
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Prognosis
If therapy is given in time , healing begins within a few days and progresses slowly until the normal bony structure is restored
It is not a fatal disease,but complications are more likely to cause death of rachitic children than normal children
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Prevention
Can be prevented by exposure to ultraviolet light
Administered vitD :daily requirement of vitamin D is 10µg or 400IU
Vitamin D should also be administered to pregnant and lactating mothers
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