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vitamin D deficiency
Vitamin D is a group of fat-soluble prohormones that are produced in the skin upon exposure to sunlight. The two major forms are vitamin D2 and vitamin D3. Vitamin D regulates calcium and phosphorus levels in the blood and promotes bone formation. Deficiency can cause rickets in children, characterized by soft and weak bones, and osteomalacia in adults. Rickets is treated with high doses of vitamin D orally or via injection to induce healing. Requirements are met by sunlight exposure or ingestion in foods like fortified milk. Too much vitamin D can cause hypercalcemia and symptoms like vomiting.
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vitamin D deficiency
- 1. Resource Person:-Prof.Dr.A.K.Dutta Presented by:-Prateek Singh
- 2. Vitamin D isa group of fat-soluble prohormones. Two major forms of which are vitamin D 2 (or ergocalciferol) and vitamin D 3 (or cholecalciferol). Production is greatest in the stratum basale and stratum Produced in skin spinosum . exposed to sunlight, specifically
- 3. Functions of VitaminD Regulates the calcium and phosphorus levels in the blood by promoting their absorption from food in the intestines. Promotes bone formation and mineralization . Inhibits parathyroid hormone secretion from the parathyroid gland. Affects the immune system by promoting immunosuppression, phagocytosis, and anti-tumor activity
- 4. Dietary sources of vitamin-D Fortified foods especially dairy products, cereals and vit. Supplements. Fish, liver, oils, egg yolk & butter. Infants: obtain vit D supplement from mothers milk, infant formulas, cow milk .
- 5. Why Vitamin Ddeficiency occurs? Due to:- Inadequate sunlight exposure. Poor access to micronutrients rich food. Disorder that limit its absorption. Deficient soil quality. Impaired conversion into active metabolites. Possible role of dietary fibers.
- 6. These lead to:- Learning disability Impaired work capacity. Increased susceptibility to infection
- 7. Deficiency causes:- Inchildren :- RICKETS:- Bone softening diz., deformity of long bones occur. In adults :- OSTEOMALACIA :- Bone thinning disorder,proximal muscle weakness & bone fragility. OSTEOPOROSIS:-Decrease bone minerilzation & inc. Bone fragility.
- 8. RICKETS:- Rickets is characterized by bone deformities due to incomplete mineralization, resulting in soft & pliable bones and delay in teeth formation. The weight bearing bones are bent to form bow legs
- 9. Risk factors Breast-fed infants whose mothers are not exposed to sunlight . Breast-fed infants who are not exposed to sunlight . Lactose intolerant. Individuals with red hair have a decreased risk for rickets due to their greater production of vitamin D in sunlight.
- 10. Pathogenesis of Rickets Appears to develop in 3 stages:- 1 st stage Absence of adequate stores In supply of 1,25 dihydroxy vit D Intestinal absorption of Ca & P Release of parathyroid hormone 1,25 (OH)2 vit D3 25(OH) vit D (in kidney) Absorption of Ca & P Mobilization of Ca & P from bone
- 11. 2 ndstage:- Relative Hyperparathyroidism Phosphaturia Negative phosphorus balance Hypophosphatemia
- 12. 3 rdstage:- Relative hyperparathyroidism Depleted 25(OH) vit D Impaired production of Adequate quantity of 1,25(OH)2 vit D3 Intestinal absorption of Ca & P
- 13. Signs and Symptoms Bone pain or tenderness. muscle weakness ( rickety myopathy or "floppy baby syndrome") syndrome Increased tendency for fractures (easily broken bones), especially greenstick fractures Hypocalcemia Tetany Craniotabes (soft skull) Skeletal deformity:Cranial, spinal, and pelvic
- 14. Bowed legs(genu varum) Costochondral swelling ( "rickety rosary" or "rachitic rosary") Knock-knees (genu valgum) or "windswept knees. Harison’s sulcus and pot belly
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- 16. Treatment:- Natural &artificial light are effective therapeutically but oral administration preferred. Administration of 15,000ugm or 6,00,000 IU of vit.D 3 orally or I.M. induces rapid healing. If healing lines of rickets is not seen on x- ray plate of bone within 3-4 weeks of therapy, the above dose may be repeated . Cases who respond to this therapy are further put on 400 units or 10ugm of vitamin D 3 per
- 17. Requirement Body needsare met entirely by conversion of 7 dehydrocholesterol to vit D 3 in skin Or in absence of exposure to UV light, it can be met entirely by ingestion of Vit D The recommended dietary intake for vit D by infants has been accepted as 200IU/day and children 400IU/day
- 18. Hypervitaminosis – D Signs & symptoms - similar to idiopathic hypercalcemia. Symptoms include:- Hypotonia, anorexia, irritability, constipation, polyuria, pallor Aortic stenosis, vomiting Hypertension Retinopathy Urine shows proteinuria Metastatic calcification as revealed by x- rays Generalized osteoporosis T/t includes discontinuation of vit D &
- 19. References :- Essential Pediatrics by O . P . Ghai Textbook of Preventive & social medicine by K . Park www.mc.vanderbilt.edu
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