Ricketts

Question 1

What are the features of nutrional ricketts

Answer 1

Low Ca intake
Low Vit D levels intake or malabsorption
raised ALP
X-ray changes metaphysis flaring / osteopenia / patholocal #

Question 2

Ricketts

Answer 2

Need low ViT D and low Ca to get Ricketts

Low vit d alone not enough if good Ca intake

Question 3

Risk factors for Vit D def

Answer 3

1 low intake
maternal low Vit D in ANC
Exclusive BF and prolonged
Dark skinned
Poor sun exposure eg avoid sun
2 low absorption eg small intestine / pancreatic/ biliary obstruction
3 increased degradation/ decreased synthesis
Drugs eg anti epilepsy drugs / steriods
Liver disease
Obesity

Question 4

How do you assess Ca deficiencies

Answer 4

History blood test alone not useful
Def <300mg per day
Sufficient 500mg per day

Question 5

Features of Ricketts

Answer 5

1 metabolic HypoCa seizures/ cardiomyopathy/ laryngospasm/ neonatal tetany
2 skeletal muscular abnormalities bow legs etc/ osteopenia / craniotabies
3 growth and development FTT, DD,Iron def anaemia
4 biochemistry
Low/normal Ca
Low /normal Phosphate
HIGH ALP
low 25OH Vit D Check the parents , siblings and child

Question 6

Treatment of Ricketts

Answer 6

Vit D and Ca++ oral

Only use IV if fitting and central line only

Question 7

Prevention of Vit d def

Answer 7

All children should have 400IU Vit d for first 12/12 of life
If at risk >12/12 600IU vit d
2 all pregnant women should had 600IU. No extra Ca++ needed