VITAMIN D DEFICINCIES

VITAMIN D
• D2- Calciferol, D3 – Cholecalciferol
• Vit D stimulates normal mineralization of bones and teeth and promotes
intestinal absorption of calcium and phosphorus.
• It enhances tubular reabsorption of phosphate and calcium.
• It also contributes towards normal growth and development of children.
SOURCES OF VIT D
1. Sunlight
2. Animal food
• Liver
• Egg yolk
• Butter, cheese
• Fish & Fish liver oil
• Milk
RECOMMENDED DAILY ALLOWANCES
• For infants -: 5.0 microgram (200 IU)
• For children-: 5-10 micrograms (200-400 IU)
DEFICIENCY OF VIT D
• Rickets
• Bony deformity
• Growth retardation
• Muscular hypotonia in children
• Osteomalacia in adult women
RICKETS
• Vit D deficiency is mainly found in rickets.
• Developed in children between 6 months to 2 yrs of age.
• It is a disease of growing bones.
• In ricket, the process of proliferation, degeneration, and calcification of
bones are incomplete.
CLINICAL FEATURES
• Initial features are irritability, restlessness, and sweating over the head
especially during sleep.
• The early signs of rickets is carniotabes:- which develops due to softening
and thinning of skull bones, mainly occipital and posterior parietal bones,
which felt like ping pong ball, if compressed by thumb.
• Large size head
• Delayed closure of fontanels
• Frontal and parital bossing
• Box-shaped head with flat vertix.
Bony deformities of chest include:-
1. Prominent costochondral junctions(rachitic rosary)
2. Pigeon chest deformity
3. Horizontal depression of lower border of chest(Harrison’s groove)
4. Violin shaped deformity of chest(pectus excavatum)
Spinal deformities include:-
1. Scoliosis
2. Kyphosis or lordosis
Deformities of limb include:-
1. Knock-knee(genu valgum)
2. Bowlegs(genu varum)
3. Broadening of wrist and ankles
Other features are:-
• Coxavera
• Flat feet
• Delayed eruption of teeth
• Pot belly(protuberent abdomen due to marked hypotonia of abdominal
muscles.
• Visceroptosis
• Growth failure
• Neonatal cataract
DIAGNOSIS
• Diagnosis is based on clinical features, biochemical findings and x-ray
findings .
MANAGEMENT
• Specific treatment consists of administering a single massive dose of vitD
orally or intramuscularly.
• Gross orthopedic deformity needs surgical correction (osteotomy).
• If there is malabsorption, steatorrhea then should be treated.
• Diet should have adequate amount of vitD from animal foods.
• The child should be encouraged to play outside for longer period for
exposure to sunlight.
OVERDOSE OF VIT D
• Hypotonia
• Anorexia
• Nausea
• Abdominal cramps
• Diarrhea Or constipation
• Irritability
• Polydipsia
• Pallor
• Drowsiness
• Failure to thrive
PREVENTION OF VIT D DEFICIENCY
• Health education and promotion of awareness
• Exposure of the child to sunlight, avoidance of overclothing and provision
of proper housing.
• Improvement of dietary habit of vit D.
• Regular health supervision of children to detect the features of vitD
deficiency conditions and early interventions of prevention and treatment.
• Adequate treatment of childhood diseases like malabsorption states,
diarrheal diseases etc..
• Congenital rickets can be prevented by preventing osteomalacia of
mothers.
• Promotion of supply of milk with vitD fortification.

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