Hello everybody,
Today we are talking about the way you can diagnose and treat rickets with.
First of all, what is RICKETS??
it is the disease of Vitamin D deficiency.
Vitamin D is very important for maintaining your calcium level normal which in turn maintain your bones ,muscles and ligaments intact.
Daily requirement of VIT D:
The normal requirement of vitD daily is 400IU.
what are the causes of infantile rickets??
1-vit D deficiency:
1-due to lack of exposure to sun rays
2-increased needs of vit D as in prematures and twins
3-congenital rickets due to defective storage of vit D from the mother
2-defective activation of vit D:
1-congenital renal disease
2-liver disease
3-deficiency of 1-hydroxylase enzyme and 25-hydroxlase enzyme which are responsible for the activation of vit D at the liver and kidney respectively.
3-defective vit D absorption:
1-malabsorption syndromes like celiac disease and chronic diarrhea
2-rachitogenic diet(yoghurt and cerials)
4-end organ resistance (type 2 rickets).
clinical picture of rickets:
symptoms: like delayed sitting ,standing,walking and teething
signs:
Head signs:
1-craniotabes:his head felt like a bing bong ball
2-wide anterior fontanel and delayed closure
3-caput quadratum due to frontal and parieta bossing.
chest signs:
1-rackitic rosary which is enlargement of costochondral junctions and felt as rows of beads
2-pigeon chest deformity
3-Harrison’s sulcus : horizontal groove at the line of attachment of the diaphragm and the sof rips
Extremities signs:
1-deformities like genu varum and genu valgum
2-green stick fractures seen only on x ray
3-spinal cord deformities like kyphosis or lordosis or scoliosis.
in addition to the bone signs there will be muscle hypotonia and ligament laxity.
Investigations:
LAB:
1-Alkaline phosphatase: is high
2-calcium is normal due to compensatory hyper parathyroidism
3-phosphate is low due to hyper parathyroidism
so the Ca and P solubility product is low <30
hence there will be defect in mineralization of bones and the symptoms appear.
Radiology
X ray wrist: there will be cupping ,fraying and broadening at the lower ends of radius and ulna.
widening of distance between calcified ends of ulna and radius and metacarpals
green stick fractures.
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