Saturday, May 9, 2020

Rickets - Short Note - Paediatrics

Vitamin D deficiency


    • Bony deformity and rickets.
    • Without bone abnormalities but with symptoms of hypocalcaemia, i.e. seizures, neuromuscular irritability (tetany), apnoea, stridor. (common before 2 years of age and in adolescence-high demand for calcium in rapidly growing bone results in hypocalcaemia before rickets develops)

Rickets


    • Rickets signifies a failure in mineralisation of the growing bone or osteoid tissue.
    • Failure of mature bone to mineralise is osteomalacia.

Aetiology

Nutritional (primary) rickets

Risk factors

• Living in northern latitudes
• Dark skin
• Decreased exposure to sunlight
• Maternal vitamin D deficiency
• Diets low in calcium, phosphorus and vitamin D, e.g. exclusive breast-feeding into late infancy
• Macrobiotic, strict vegan diets
• Prolonged parenteral nutrition in infancy


Intestinal malabsorption
• Small bowel enteropathy (e.g. coeliac disease)
• Pancreatic insufficiency (e.g. cystic fibrosis)
• Cholestatic liver disease
• High phytic acids in diet (e.g. chapattis)

Defective production of 25(OH)D2
• Chronic liver disease

Increased metabolism of 25(OH)D3
• Enzyme induction by anticonvulsants (e.g. phenytoin, phenobarbital)

Defective production of 1,25(OH)2D3
• Hereditary type I vitamin D-resistant (or dependent) rickets (mutation which abolishes activity of renal hydroxylase)
• Familial (X-linked) hypophosphataemic rickets (renal tubular defect in phosphate transport)
• Chronic renal disease
• Fanconi syndrome (renal loss of phosphate)

Target organ resistance to 1,25(OH)2D3
• Hereditary vitamin D-dependent rickets type II
(due to mutations in vitamin D receptor gene).


Clinical manifestations


• Misery
•  Failure to thrive/short stature
•  Frontal bossing of skull
•  Craniotabes (ping-pong ball sensationof the skull elicited by pressing firmly over the occipital or posterior parietal bones)- Earliest sign
•  Delayed closure of anterior fontanelle
•  Delayed dentition
•  Rickety rosary (palpable or visible costochondral junctions)
•  Harrison sulcus (a horizontal depression on the lower chest corresponding to attachment of the softened ribs and with the diaphragm)
    • Pigeon chest / violin case deformity
    • Pot belly
    • Kyphoscoliosis
•  Expansion of metaphyses (especially wrist in crawling individuals, in ankle in walking infants)
•  Bowing of weight-bearing bones
    • Knock knees
•  Hypotonia
    • Proximal myopathy resulting waddling gait
    • Bone pain- axial skeleton, spine, shoulders, ribs & pelvis
    • Localized pain due to green stick fractures
•  Seizures & tetani due to hypocalcaemia

Diagnosis

• Dietary history for vitamin and calcium intake
• Blood tests – serum calcium is low or normal, phosphate low, plasma alkaline phosphatase activity greatly increased, 25-hydroxyvitamin D may be low and parathyroid hormone elevated.
• X-ray of the wrist joint – shows cupping and fraying of the metaphyses and a widened epiphyseal plate, looser’s zone

Management

Nutritional rickets is managed by,
    • Balanced diet,
    • Correction of predisposing risk factors
    • Administration of vitamin D3 (cholecalciferol).

Healing occurs in 2–4 weeks and can be monitored from the,
    • Lowering of alkaline phosphatase,
    • Increasing vitamin D levels
    • Healing on X-rays (but complete reversal of bony deformities may take years)

2 comments:

  1. Good day to all am so happy sharing this great testimony on here, I was diagnose of Stage IV colon cancer.i was checking for solution in the internet then miraculously i came Across Dr Itua herbal center the powerful herbal doctor that Cure Numerous Diseases such as-Thyroid Cancer,Uterine cancer,Fibroid,Angiopathy, Ataxia,Arthritis,Amyotrophic Lateral Sclerosis,Brain Tumor,Fibromyalgia,Fluoroquinolone ToxicityBladder cancer,Brain cancer,Hiv,Herpes,Esophageal cancer,Gallbladder cancer,Gestational trophoblastic disease,Head and neck cancer,Hodgkin lymphoma
    Intestinal cancer,Kidney cancer,Hpv,Lung cancer,Melanoma,Mesothelioma,Multiple myeloma,Neuroendocrine tumors
    Non-Hodgkin lymphoma,Oral cancer,Ovarian cancer,Sinus cancer,Hepatitis A,B/C,Skin cancer,Soft tissue sarcoma,Pancreatic Cancer,Spinal cancer,Stomach cancer,Vaginal cancer,Vulvar cancer,
    Testicular cancer,Tach Diseases,Leukemia,Liver cancer,Throat cancer,
    Syndrome Fibrodysplasia Ossificans ProgresS sclerosis,Alzheimer's disease,Chronic Diarrhea,Copd,Parkinson,Als,Adrenocortical carcinoma Infectious mononucleosis. ,I contacted him based on the testimonies I?m seeing about him on the internet, I was cured too by him, kindly contact him today through his email he can help you. drituaherbalcenter@gmail.com web and his herbal medicines will set you free from any human diseases,all thank you Dr Itua herbal center for your kind help in my life. His Mobile number Whatsapp.+2348149277967.

    ReplyDelete
  2. I find something in herbal medicine good to share on here with anyone suffering from the disease such as HIV, Herpes, Hepatitis or Chronic Lyme Disease,Parkinson's disease,Schizophrenia,Lung Cancer,Breast Cancer,Colo-Rectal Cancer,Blood Cancer,Prostate Cancer,siva.Fatal Familial Insomnia Factor V Leiden Mutation ,Epilepsy Dupuytren's disease,Desmoplastic small-round-cell tumor Diabetes ,Coeliac disease,Creutzfeldt–Jakob disease,Cerebral Amyloid Angiopathy, Ataxia,Arthritis,Amyotrophic Lateral Scoliosis,Fibromyalgia,Fluoroquinolone ToxicitySyndrome Fibrodysplasia Ossificans ProgresS sclerosis,Seizures,Alzheimer's disease,Adrenocortical carcinoma.Asthma,Allergic diseases.Hiv_ Aids,Herpe ,Copd,Glaucoma., Cataracts,Macular degeneration,Cardiovascular disease,Lung disease.Enlarged prostate,Osteoporosis.Alzheimer's disease,
    Dementia.
     Lupus as well.Dr Itua herbal made cure my HIV and gave me hope that he can cure all types of diseases I believed him) I do the best of myself that I can do, I went for a program in west Africa about fashion on another side I was HIV positive. I walk through a nearby village for our program schedule then I found a signage notice that says Dr Itua Herbal Center then I asked my colleagues what all about this very man called Dr Itua, She told me that he's a herbal doctor and he can cure all kind of disease i walked to him and explain myself to him as I'm a strangler out there he prepared me herbal medicine and told me how to drink it for two weeks, when I get to my hotel room I take a look at it then says a prayer before I drank it not knowing after two weeks I went to test and I found out I was negative I ran to him to pay him more but he refuses and says I should share his works for me around the globe so sick people can see as well. I'm writing a lot about him this season so that is how I was cured by drinking Dr Itua herbal medicine, He's A caring man with a godly heart. Well - everything I decided all went through for me and how you're going to treat this new aspect to your life. You don't have to suffer alone, and it's okay to ask for help. It also doesn't have to be a constant demon, as you'll get to know your body and yourself in a much deeper way than most people. Take advantage of this, as it will help you appreciate Africa Herbal Made.
    Dr Itua Contact Information.
    Email...drituaherbalcenter@gmail.comWhatsapp Number....+2348149277967        

    ReplyDelete