Rickets of Vitamin D Deficiency
维生素 D 缺乏性佝偻病
Definition
Rickets is the term signifying a failure in mineralization of growing bone or osteoid tissue.
Etiology
296—310nm
ultraviolet rays
Inadequate exposure in sunlight
Prevalence
Spring > Autum
City > Countryside
Dark skin > White skin
7-dehydrocholesterol VitD3
EtiologyInsufficient intake of VitD3Insufficient intake of calcium
absoption
inhibition
VitD lactose Amino acid
P↑
fibersvegetable
Etiology
adolescentsRapid growth
Low- birth weight infants
Adolescents
Etiology
Diseases Celiac disease
Anticonvulsant therapy
Cystic disease
phenobarbital
Etiology
Others
Nutritional status of mother
Eating habit
Nutrients deficiency Zn
VitC
Protein
Feeding pattern
Pathology7
Activation of VitD
VitD3
25(OH)D3
1,25(OH)2D3
7- 脱氢胆固醇
Pathology
Resume Ca 1,25(OH)2D3↓
Ca & P absorption ↓
Parathiroid ↑ calcium (±) & P ↓
Ca ×P↓
DemineralizationOsteomalaci
a
deformity
Clinical manifestation-skeleton
Skull<6mon craniomalacia ( 颅骨软化 )
6-12mon cephalus quadratum ( 方颅 )
Large anterior fontanel ( 囟门大 )
Teeth eruption delay ( 出牙迟 )
Clinical manifestation-skeleton
Costochondral-rosary (肋骨串珠)
Chicken breastChicken breast (鸡胸)(鸡胸)
Harrison groove ( 哈氏沟 )
Thorax
Funnel breast (漏斗胸)
Clinical manifestation-skeleton
Extremities
6-12mon
>12mon
epiphyseal enlargement at wrists and ankles
bowlegs
knock-knees
Clinical manifestation-skeleton
Spine and pelvis
Rachitic dwarfism
ScoliosisDeformities
kyphosis
Clinical manifestation-muscle
Motor delay
Clinical manifestation-neurologic symptoms
Restless
Night cry or terror
sweat
X-ray
( 骨样组织堆积 )
( 干骺端改变 )
Periosteal osteoid
Rachitic metaphyses 钩样杯口
毛刷
Diagnosis
HistoryClinical observationSerum calcium level (±)Serum phosphorus level↓Serum alkaline phosphatase level↑
Treatment
Natural sunlight exposureOral administration of VitD
VitD 2000-6000 IU/d ×2-4w 400IU/dImpulsive injection of VitD
VitD 30-60 万 IU 2-3 timesCalcium 0.5-1.0g/dOthopedics
Prevention
Breast feeding
Exposure to sunlight
Oral administration of VitD 400IU/d
VitD for pregnant and lactating mothers
obesity
肥胖症
Definition
Energy intake > energy expenditureOverweightBody fat over-accumulated
EtiologyEtiology-primary obesity-primary obesity
More junk food or high-energy foods
Less exercise
Genetic predisposition
ob dbleptin
EtiologyEtiology- secondary obesity- secondary obesity
Genetic
Matabolic or endocrinologic diseases
Patho-physiologyPatho-physiology
Serum insulin density ↑Serum insulin density ↑Lipolysis Lipolysis ↓↓Fat synthesis ↑Fat synthesis ↑Fat tissue ↑Fat tissue ↑
Number of fat cell ↑Number of fat cell ↑
Size of fat cell ↑Size of fat cell ↑
Carbohyrate mealCarbohyrate meal
Insulin secretion ↑Insulin secretion ↑Use of fatty acid↓Use of fatty acid↓
3 mon3 mon1yr1yr
adolescentadolescent
Patho-physiologyPatho-physiology
Serum triglyceride↑
General cholerterol↑
Growth homone ↓
Clinical Manifertations
Age—infant , 5-6yr, adolescent
Excessive high caloric intake
Heavy and tall
Bone age advanced
Sleep apnea
White or purple strial
Puberty occur early
Diagonosis
Weight × > 20%( same sex , height)
Mild × >20-29%
Moderate × >30-39%
Sever × >40-45%
Extreme sever × >60%
Body mass index , BMI
BMI=weight (kg) / height (m) 2BMI (same sex , age) 95 percentile or >30
Treatment
Modification of diet and caloric content
Low fat and carbohydrates
High protein
Treatment
<6m
6-9m
<5y
5-10y
10-14y
110cal/kg.d90cal/kg.d600-800cal/kg.d
800-1000cal/kg.d
1000-1200cal/kg.d
Dietary regimen
Treatment
Energy distribution
carbohydrate proteinFat
20-25% 40-45% 30-35%
High quality protein
1.5-2.5g/kg.d
Treatment
Exercise program
Psychotherapy
Gene therapy
Family therapy
-behavior modification
Treatment
Less fat food in late pregnantBreast feedingHealthy food habitOutdoor activityNutritional monitor