RICKETS

Deficiency of vitamin d in growing children before the epiphysis have fused results in failure of growing bone to mineralise known as ricket.

Types and causes
-secondary r.
Due to malabsorption states eg.coeliac dis,intestinal resection,low calcium.vit d intake, inadequate sunlite expose,
-resistant r.
Eg.familial r.,vit d dependant r.
-renal r. In chronic renal failure
-drug induced r.anticonvulsants
-tumour induced r.

C/f
-infant appears restless fretful and pale with flabby muscles
-poor dentition and late eruption
-skeletal deformities.seizures.tetany.
-prone to respiratory and gi infections.
-craniotabes wid egg shell cracking feeling
-rickety rosary n pigeon shaped chest.
-harrisons groove
-frontal bossing of skull
-delayed closure of ant fontanellae
-kyphosis,genu valgum or varum
-triradiate pelvis.
-infantile tetany.

Investigations
-wrist radiography
Lower ends of the shaft of radius and ulna become splayed and epiphyseal surfaces appear fuzzy and ill defined.unossified zone bet shaft n radial epiphysis is widened.
-low serum calcium
-low serum phosphate
-increase alk phosphatase activity
-plasma 25 OH vit D3 are low.

Treatment
-correction of underlying cause
-supplementation of dietary sources of calcium and vitamin d.
-ergocalciferol 1.5 to 6 lac IU oral or im as a single dose.
-for type1 vit d dependant r,calcitriol require
-for type 2 high doses of calcitriol n calcium
-for familial r,oral phosphorus n calci.