(Posted:07-Jun-2015)

Rickets is a childhood disease which occur due to vitamin D deficiency. Bone is a composed of protein matrix called osteoid & mineral phage consisting of calcium & phosphate. Rickets occure due to unmineralized matrix or decreased mineralization at the growth plate. Rickets may be defined as:disease of growing bone,occuring in children,before fusion of the epiphysis,is due to unmineralized matrix at the growth plate. Causes of Rickets: Nutritional vitamin D deficiency. Malabsorbtion Increased degradation Decrease liver 25 hydrolase Chronic kidney disease Dietary deficiency. Clinical features of rickets: General: Failure to trive Proximal muscle weakness Protruding abdomen Fracture Head: Frontal bossing Craniotabs Wide open anterior frontanel Craniosynostosis Denta carries Chest: Harrison groove Recurrent chest infection Back: Kyphosis,scoliosis,lordosis Extremities: Widening of wrist and ankle, Anterior bowing of femur and tibia.leg pain,coxa vera. Symptoms of hypocalcemia: Laryngeal stridor,Seizure,Tetany. Diagnosis of Rickets: Detailed history of patient: cheif complaine,drug history,feeding history,developmental history,family history,socioeconomical condition. Through physical examination Relevant laboratory investigations Investigation: 1)X-ray of wrist &ankle; joint. 2)Biochemical test: Serum calcium,phosphorus,alkaline phosphatase,parathyroid hormone,25 Hydroxy vitamin D,1,25 dihydroxy vitamin D3,serum creatinine,serum electrolytes,urine analysis. Treatment: a)Vitamin D therapy: 300000-600000 IU of vitamin D given orally or I/M as 2-4 doses over 1 day. b) Daily intake of vitamin D 2000-5000 IU/day for 4-6 weeks. Prognosis:Most children have excellent respose to treatment. Bony deformity improves dramatically Radiological healing occurs in few months. Prevention: *Ingestion of diet enriched with vitamin D. *Most causes of nutritional rickets can be prevented by universal administration daily multivitamin containin 200-400 IU of vitamin D to children who are breast feed.