GIT

Rickets

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

Etiology

1- vitamin D disorders(nutritional , congenital , secondary, chronic renal failure) 2- calcium deficiency(diet, malabsorption) 3- phosphorous deficiency( diet, antacid) 4- RENAL LOSSES(X-linked hypophosphatemic rickets , RTA)

Nutritional Vitamin D Deficiency

CLINICAL FEATURES OF RICKETS
GENERAL Failure to thrive Listlessness Protruding abdomen Muscle weakness (especially proximal) Fractures

HEAD Craniotabes (softening of the cranial bones and can be detected by applying pressure at the occiput or over the parietal bones. The sensation is similar to the feel of pressing into a Ping-Pong ball and then releasing) Frontal bossing Delayed fontanel closure Delayed dentition; caries Craniosynostosis

CHEST Rachitic rosary Harrison groove Respiratory infections and atelectasis*

BACK Scoliosis Kyphosis Lordosis

EXTREMITIES Enlargement of wrists and ankles Valgus or varus deformities Windswept deformity (combination of valgus deformity of 1 leg with varus deformity of the other leg) Anterior bowing of the tibia and femur Coxa vara Leg pain


Most cases of rickets are diagnosed based on the presence of classic radiographic abnormalities. The diagnosis is supported by physical examination findings and a history and laboratory test results that are consistent with a specific etiology

LABORATORY TESTS

The initial laboratory tests in a child with rickets should include serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone (PTH), 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D3, creatinine, and electrolytes

Treatment

Children with nutritional vitamin D deficiency should receive vitamin D and adequate nutritional intake of calcium and phosphorus. There are 2 strategies for administration of vitamin D. With stoss therapy, 300,000-600,000 IU of vitamin D are administered orally or intramuscularly as 2-4 doses over 1 day. Because the doses are observed, stoss therapy is ideal in situations where adherence to therapy is questionable. The alternative is daily, high-dose vitamin D, with doses ranging from 2,000-5,000 IU/day over 4-6 wk. Either strategy should be followed by daily vitamin D intake of 400 IU/day if <1 yr old or 600 IU/day if >1 yr, typically given as a multivitamin