| ID | 161 |
|---|---|
| Name | RICKETS |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | Investigations: 1. Radiological examination- of the wrist will show the out line of the joint is blurred and fuzzy and the epiphyseal zone becomes thickened and the distal ends of the shafts are widened. When fully developed this shows a typically ‘saucer’ deformity. 2. Chemical pathology- plasma calcium tends to fall from its normal level. More commonly the serum phosphate falls. There is an increase in alkaline phosphatase- is of diagnostic value. |
| Management | |
| Introduction | Rickets is a disease of growing bone characterised by defective mineralisation due to impaired calcium and phosphorus metabolism, which occurs when infants or children obtain insufficient vitamin-D. |
| History | |
| Etiology | |
| Clinical Features | Clinical features: The infant with rickets is restless, fretful and pale, with flabby muscles. Sweating of the head is common. The abdomen is distended. The infant is prone to respiratory infections and gastrointestinal upsets. Development is delayed, the teeth often erupt late, there is failure to sit, stand, crawl, and walk at normal ages. The bony changes are the most characteristic signs of rickets. There is often craniotabies, enlargement of the epiphysis, at the lower end of the radius and at the costochondral junctions of the the ribs (rickety rosary); there may be bossing of the forntal and parietal bones. There may deformities such kyphosis, knock knees or bow legs. Tetany may develop. |
| Preventions | |
| Treatment | Treatment: 1. Vitamin-D therapy: A therapeutic dose of ergocalciferol (D2) 250-1000mg or cholecalciferol (D3) 25-125ug (1000-5000 i.u.) daily. Clinical improvement can be shown by an elevation of serum 25 (OH)D and a reduction in parathyroid hormone (PTH). With vitamin-D treatment serum alkaline phosphatase sometimes rises initially as bone mineralisation increases, later on it falls to within normal range. After 3-4 months, treatment can be stopped or reduced to the prophylactic dose of cholecalciferol (D3) 10-20ug daily. Children can be given halibut-liver oil in a very small dose (1ml). For severe cases needing 125jig or more daily. Synthetic calciferol is useful. 2. In addition to vitamin-D, rachitic infants and children require an ample supply of calcium, the best source of which is milk. 3. If tetany is present i.v. calcium gluconate 5-20c.c 10% solution to be given slowly. |
| Complications | |
| Prognosis | |
| Types | Types of rickets: Nutritional ricket -Secondary ricket vitamin-D deficiency in nutrition due to liver and kidney disease vitamin-D dependent ricket vitamin-D resistant ricket |
| Classification | |
| Observation | |
| Pathology |
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