维生素D缺乏性佝偻病(英文)
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2.The advanced stage
Blood biochemical examination: Ca ↓, P ↓↓，CaP <30, AKP ↑
(In addition to the slightly lower serum calcium, the other indicators have changed more significantly)
About Vitamin D
Vitamin D two forms VitD2 VitD3
most as irradiated ergosterol，largely replaced the fish liver oils as source
available in human skin as 7-dehydrocholesterol (7-HDC)
Purpose
1. Be familiar with etiology and pathogenesis of rickets . 2.To master their clinical manifestations, diagnosis ,treatment and prevention . 3. To understand their differential diagnosis.
Differential diagnosis
Scurvy:
Clinical Manifestation
3.Recovery stage Symptoms gradually abate or disappear Signs gradually abate or disappear Blood biochemical examination:
Ca and P return to normal CaP returns to normal AKP may be return slowly to normal
The early stage Advanced stage
falling More low
falling Slightly lower
Normol or increased increased
Recovered stage
Sequelae stage
Normol
Normol
Normol
Normol
Ingested from
food
Human skin contains 7dehydrocholesterol
Vit D3
(ultraviolet rairradiation)
Liver(25-hydroxylase) 25-(OH) -D3（ 25-dihydroxy vitaminD3） kidney (1-hydroxylase) 1,25-(OH) 2-D3
X-ray it returns to normal after 2 to 3 weeks
Clinical Manifestation
4.Sequela stage Age:more than 2 years old Symptoms:without any clinical symptoms Signs:in severe case the deformities of bones may remain Blood biochemical examination: all the levels of
Clinical Manifestation
1.Early stage
Age:especially 3 months baby neuro-psychic symptoms:express excitability of the nervous system Sign: the loss of hair in the occipital position blood biochemical examination: Ca normal or ,P normal , Ca P , AKP(alkaline phosphatase) or normal X-ray No obvious skeletal change
Clinical Manifestation
2.The advanced stage
X-ray:Calcification zone of long bone disappeared,
epiphyseal cartilage disc widened (> 2 mm); bone and bone cortical thinning; may have backbone bending deformity.
Definition
Rickets is a very common nutritional deficient disease in young children especially under two years old of age. Vitamin D deficiency cause rickets, a metabolic disorder of calcium and phosphorus with a failure to mineralize osteoid tissue of growing bone resulting in bony deformities.
Become normol After 1-2 month
Normol
change more significantly
Diagnosis
Medical history: a history of inadequate intake of
vitamin D and on clinical observation
Rickets of vitamin D deficiency
Self-introduction
Good afternoon,ladies and gentlemen. I am very honored to deliver this speech today. The topic of my speech is "Rickets of vitamin D deficiency".
(1, 25-dihydroxycholecalciferol) Vitamin D must go through two hydroxylation only can play a biological effect in the body. The liver cells first hydroxylate, and generate 25-hydroxy vitamin D3. And it is rehydroxylated under the action of renal hydroxylase to produce a highly biological activity.
The regulation of vitamin D
autoregulation
PTH
（＋）
（－）
1,25(OH)2D3
CT
（－）
1,25(OH)2D3 （＋）
Calcium Phosphate
1,25-(OH)2D3 has the function of self-feedback.At the same time,When the blood calcium is too low, PTH increases. When the blood calcium is too high, CT secretes, which inhibits the production of 1，25-(OH)2D3.The decrease of blood phosphorus can directly promote the increase of it, while high blood phosphorus inhibits its synthesis
Square head
Clinical Manifestation
2.The advanced stage 1 year old
Thoracic deformities can be seen in children 1 year old.
Thorax:Rachitic rosary Harrison groove Chest deformity Children are late in standing and walking.
Etiology
1. 2. 3. 4.
rickets
Lack of sunshine:The children spend too little time Underfeeding: The children don't have enough food Rapid growth: The baby grows too fast to have enough Influence of diseases: some diseases can lead to Influence of medicine: some drugs can also lead
2.The advanced stage
Cat back
Chicken breast
Spinal column
Clinical Manifestation
2.The advanced stage
bracelets of hands bow legs knock knees
Clinical Manifestation
outside under the sun
containing vitamin D
calcium
5.
to rickets
Clinical Manifestation
Four Stages
Early stage
The advanced stage
Sequelae stage
Recovery stage
Clinical Manifestation
1.Early stage
the loss of hair in the occipital position
Clinical Manifestation
2.The advanced stage 6 -8months
Head: within 6 months a derby hat or ping pong ball. 7-8 months Brain softening,like
Symptoms
By X-ray examination
Confirmed chemically
Diagnosis
Gold Standard X-ray
1,25-(OH)2D3
Etiology
Symptoms
Rickets of vitamin D deficiency
Blood biochemical examination
Ca, P and AKP are normal
X-ray the lesion disappeared
Clinical Manifestation
Biochemical examination:
Blood phosphor Blood calcium （ P） （Ca） Alkaline phosphatase
Clinical Manifestation
2.The advanced stage
Funnel breast
Rachitic rosary
Clinical Manifestation
2.The advanced stage
Harrison grooves
Clinical Manifestation
Differential diagnosis
:irregular、concave outlines of the distal ends of the bones ,no roentgenographic evidence of fraying
Chondrodystrophy
Chondrodystrophy
Blood biochemical examination: Ca ↓, P ↓↓，CaP <30, AKP ↑
(In addition to the slightly lower serum calcium, the other indicators have changed more significantly)
About Vitamin D
Vitamin D two forms VitD2 VitD3
most as irradiated ergosterol，largely replaced the fish liver oils as source
available in human skin as 7-dehydrocholesterol (7-HDC)
Purpose
1. Be familiar with etiology and pathogenesis of rickets . 2.To master their clinical manifestations, diagnosis ,treatment and prevention . 3. To understand their differential diagnosis.
Differential diagnosis
Scurvy:
Clinical Manifestation
3.Recovery stage Symptoms gradually abate or disappear Signs gradually abate or disappear Blood biochemical examination:
Ca and P return to normal CaP returns to normal AKP may be return slowly to normal
The early stage Advanced stage
falling More low
falling Slightly lower
Normol or increased increased
Recovered stage
Sequelae stage
Normol
Normol
Normol
Normol
Ingested from
food
Human skin contains 7dehydrocholesterol
Vit D3
(ultraviolet rairradiation)
Liver(25-hydroxylase) 25-(OH) -D3（ 25-dihydroxy vitaminD3） kidney (1-hydroxylase) 1,25-(OH) 2-D3
X-ray it returns to normal after 2 to 3 weeks
Clinical Manifestation
4.Sequela stage Age:more than 2 years old Symptoms:without any clinical symptoms Signs:in severe case the deformities of bones may remain Blood biochemical examination: all the levels of
Clinical Manifestation
1.Early stage
Age:especially 3 months baby neuro-psychic symptoms:express excitability of the nervous system Sign: the loss of hair in the occipital position blood biochemical examination: Ca normal or ,P normal , Ca P , AKP(alkaline phosphatase) or normal X-ray No obvious skeletal change
Clinical Manifestation
2.The advanced stage
X-ray:Calcification zone of long bone disappeared,
epiphyseal cartilage disc widened (> 2 mm); bone and bone cortical thinning; may have backbone bending deformity.
Definition
Rickets is a very common nutritional deficient disease in young children especially under two years old of age. Vitamin D deficiency cause rickets, a metabolic disorder of calcium and phosphorus with a failure to mineralize osteoid tissue of growing bone resulting in bony deformities.
Become normol After 1-2 month
Normol
change more significantly
Diagnosis
Medical history: a history of inadequate intake of
vitamin D and on clinical observation
Rickets of vitamin D deficiency
Self-introduction
Good afternoon,ladies and gentlemen. I am very honored to deliver this speech today. The topic of my speech is "Rickets of vitamin D deficiency".
(1, 25-dihydroxycholecalciferol) Vitamin D must go through two hydroxylation only can play a biological effect in the body. The liver cells first hydroxylate, and generate 25-hydroxy vitamin D3. And it is rehydroxylated under the action of renal hydroxylase to produce a highly biological activity.
The regulation of vitamin D
autoregulation
PTH
（＋）
（－）
1,25(OH)2D3
CT
（－）
1,25(OH)2D3 （＋）
Calcium Phosphate
1,25-(OH)2D3 has the function of self-feedback.At the same time,When the blood calcium is too low, PTH increases. When the blood calcium is too high, CT secretes, which inhibits the production of 1，25-(OH)2D3.The decrease of blood phosphorus can directly promote the increase of it, while high blood phosphorus inhibits its synthesis
Square head
Clinical Manifestation
2.The advanced stage 1 year old
Thoracic deformities can be seen in children 1 year old.
Thorax:Rachitic rosary Harrison groove Chest deformity Children are late in standing and walking.
Etiology
1. 2. 3. 4.
rickets
Lack of sunshine:The children spend too little time Underfeeding: The children don't have enough food Rapid growth: The baby grows too fast to have enough Influence of diseases: some diseases can lead to Influence of medicine: some drugs can also lead
2.The advanced stage
Cat back
Chicken breast
Spinal column
Clinical Manifestation
2.The advanced stage
bracelets of hands bow legs knock knees
Clinical Manifestation
outside under the sun
containing vitamin D
calcium
5.
to rickets
Clinical Manifestation
Four Stages
Early stage
The advanced stage
Sequelae stage
Recovery stage
Clinical Manifestation
1.Early stage
the loss of hair in the occipital position
Clinical Manifestation
2.The advanced stage 6 -8months
Head: within 6 months a derby hat or ping pong ball. 7-8 months Brain softening,like
Symptoms
By X-ray examination
Confirmed chemically
Diagnosis
Gold Standard X-ray
1,25-(OH)2D3
Etiology
Symptoms
Rickets of vitamin D deficiency
Blood biochemical examination
Ca, P and AKP are normal
X-ray the lesion disappeared
Clinical Manifestation
Biochemical examination:
Blood phosphor Blood calcium （ P） （Ca） Alkaline phosphatase
Clinical Manifestation
2.The advanced stage
Funnel breast
Rachitic rosary
Clinical Manifestation
2.The advanced stage
Harrison grooves
Clinical Manifestation
Differential diagnosis
:irregular、concave outlines of the distal ends of the bones ,no roentgenographic evidence of fraying
Chondrodystrophy
Chondrodystrophy