Vit D (vit D2 and vit D3)

the nutritionally important forms of vitD are:

Calciferol vitamin D2 and
Cholecalciferol vitamin D3
Calciferol may be derived by irradiation of
the plant sterol,ergosterol
Cholecalciferol is the naturally occuring(per-
formed) vitamin D which is found in animal
fats and fish liver oil.
Cont…….
It is also derived from exposure to
ultravoilet rays of the sunlight which
convert the cholesterol in the skin to vitamin
D.
Vitamin D is stored largely in the fat depots.
Vitamin D is also known as kidney
hormone.
Functions of vitamin D
Intestine:promotes intestinal absorption of
calcium and phosphorous
Bone:stimulates normal
mineralization,enhances bone resorption,and
affects collagen maturation
Kidney:increases tubular reabsorption of
phosphate,variable effect on reabsorption of
calcium
Other:permits normal growth
Sources of vitamin D
Vitamin D is derived both from foods and
sunlight
Sunlight:vitamin D is synthesized by the
body by the action of UV rays on sunlight
on 7-dehydrocholesterol which is stored in
large abundance in the skin.
Liver,egg yolk,butter,cheese,and some
species of fish
Cont……
Fish liver oils,although not considered to be
a food,are the richest source of vitamin D.
Human milk
Other sources:foods artificially fortified
with vitamin D such as margarine,vanaspati
and infant foods.
 Recommended dietary allowance (RDA
adults 2.5 mcg (100 IU)

Infants and children 5.0 mcg (200 IU)

Pregnancy and 10.0 mcg (400 IU)

lactation
Cont……
1 IU of vit D = 0.025µg of
calciferol
 RICKETS

Rickets is a disorder caused by a lack

of vitamin D, calcium, or phosphate.
It leads to softening and weakening
of the bones.
Causes
Vitamin D helps the body control calcium and phosphate
levels. If the blood levels of these minerals become too
low, the body may produce hormones that cause calcium
and phosphate to be released from the bones. This leads
to weak and soft bones.
Vitamin D is absorbed from food or produced by the
skin when exposed to sunlight. Lack of vitamin D
production by the skin may occur in people who;
Live in climates with little exposure to sunlight
Must stay indoors
Work indoors during the daylight hours
Cont….
You may not get enough vitamin D
from your diet if you:
Are lactose intolerant (have trouble
digesting milk products)
Do not drink milk products
Follow a vegetarian diet
High risk for developing rickets
Breast-fed infants whose mothers are not
exposed to sunlight
Breast-fed infants who are not exposed to
sunlight
Individuals not consuming fortified
milk,such as those who are lactose intolerant
Doesn’t eat foods containing vitamin D
Cont……
People who must stay indoors,work
indoors during the daylight hours,or
live in climates with little exposure to
sunlight
Has dark skin
Occasionally rickets may also occur in
children who have disorders of the liver
Cont….
It also occurs when the kidney are unable to
retain the mineral phosphate.
Rickets may also be caused by kidney
disorders that involve renal tubular acidosis
Disorders that reduce the digestion or
absorption of fats will make it more difficult
for vitamin D to be absorbed into the body
Signs and symptoms
Rickets are characterised by growth
failure,bone deformity,muscular
hypotonia,tetany and convulsions due
to hypocalcaemia.
The bone deformity includes curved
legs,deformed pelvis, pigeon
chest,Harrison’s sulcus,rickety
rosary,kyphoscoliosis,etc.
Cont……
The milestones of development like
walking and teething are delayed.
Bone pain or tenderness,increased tendency
toward bone fractures.
Bowlegs (genu varum)in toddlers.
Knock-knees (genu valgum)in older
children.
Asymmetrical or odd shaped skull .
Cont……

Delayed formation of teeth,defects in the

structure of teeth,holes in the
enamel,increased incidence of cavities in the
teeth(dental caries).
Progressive weakness.
Decreased muscle tone (loss of muscle
strength),muscle cramps
Impaired growth,short stature(adults less than
5 feet tall)
Diagnosis
The following tests may help diagnose
rickets:
Arterial blood gases
Blood tests (serum calcium)
biopsy (rarely done)Bone
Cont…….
Bone x-rays
Serum alkaline phosphatase
Serum phosphorus
Cont……
Other tests and procedures include the
following:
ALP (alkaline phosphatase) isoenzyme
Calcium (ionized)
PTH (parathyroid hormone)
Urine calcium
Treatment
The goals of treatment are to relieve
symptoms and correct the cause of the
condition. The cause must be treated to
prevent the disease from returning.
Cont…..
Replacing calcium, phosphorus, or
vitamin D that is lacking will eliminate
most symptoms of rickets.
 Dietary sources of vitamin D include
fish, liver, and processed milk.
 Exposure to moderate amounts of
sunlight is encouraged.
Cont…..

If rickets is caused by a metabolic

problem, a prescription for vitamin D
supplements may be needed.
Positioning or bracing may be used to
reduce or prevent deformities.
 Some skeletal deformities may require
corrective surgery.
Possible complication
Chronic skeletal pain
Skeletal deformities
Skeletal fractures, may occur
without cause
Prevention
Educating parents to expose their
children regularly to sunshine
Periodic dosing(prophylaxis of young
children with vit D)
Vit D fortification of foods,especially
milk.
Periodic dosing and education appears
to be the most practical approach in the
developing contries.
Cont……..

Renal causes of vit D malabsorption

should be treated promptly
Levels of calcium and phosphorus
should be monitored regularly in
people who have renal disorders
Genetic counselling may help people
with a family history of inherited
disorders that can cause rickets
THANK
YOU