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FEATURES

Symptoms

  • Irritable child with flabby muscles
  • Delayed gross motor development
  • Delayed dentition
  • REcurrent respiratory and digestive tract infections
  • Excess sweating
  • Severe deficiency may present with Fits( especially in babies)

Signs

Head signs

  • Craniotabes- seen at 1 year old due to soft bones
  • Frontal and parietal bone bossing
  • Widening Of sutures
  • Delayed closure to anterior fontanelle

Chest Signs

  • Pigeon shaped chest
  • Rickety rosary- bead appearance of costochondral junction
  • Harrison’s sulcus
  • Kyphoscoliosis

Abdomen

  • Protruding abdomen due to weak muscles

Limbs

  • Enlarged wrist
  • Knock knees
  • Bowing of legs

TESTS done to diagnose Rickets-

The clinical features are numerous and hint the diagnosis.

Radiological features

  • Cupping/ widening and fraying of tej lower end of radius and ulna
  • Wrist X-rays- see features of reduced bone density
  • Widening of wrist

Biochemical changes

  • Plasma alkaline phosphatase is raised
  • Low phosphorus
  • Plasma calcium levels are low
  • Plasma 25- hydroxyvitamin D3 level may be low
  • Kidney function blood tests

TREATMENT

Vitamin D deficiency is treated by giving Vitamin D

  • This is given either oral vitamin tablets for 2- 3 months or as injections for 1-2 days.
  • Children less than 6 months are treated with 3000 IU per day, children 6 months to 12 months are given 6000 IU and older children are given 10,000 IU per day
  • This is followed by ensuring adequate vitamin intake either as food or supplement

 

MANAGEMENT

 

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Vitamin D doses for Vitamin D deficiency (<25nmol/l)

1. < 6 months – 3000 IU Cholecalciferol liquid /daily for 8-12 weeks
2.   6-12 months- 6000 IU Cholecalciferol liquid /daily for 8-12 weeks
 
3.   12-24 months- 6000 IU Cholecalciferol liquid /daily for 8-12 weeks or     HIGH DOSE SHORT COURSE  Single intramuscular injection of Ergocalciferol 150,000 IU;
 
4.   > 24 months-12 years  – HIGH DOSE SHORT COURSE  Single intramuscular injection of Ergocalciferol 150,000 IU;  OR   Oral Cholecalciferol 160,000 IU.over 4 days.
 
5.  12-18 years – 300 000 IU Cholecalciferol single dose or OrCholecalciferolrol 50 000 IU once weekly for 6 weeks

 

 
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 VITAMIN D DEPENDENT RICKETS TYPE1

Treatment- 1, 25 D ( calcitriol) – 0.25 to 2 microgram/day

VITAMIN D DEPENDENT RICKETS TYPE 2

Treatment- 1, 25 D( Calcitriol ) 2 microgram/ day ( upto 50-60 microgram/day)

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