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
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