RICKETS

Rickets is a disorder involving softening and weakening of the bones (of children) primarily caused by lack of Vitamin D, or lack of calcium or phosphate. It is a general disease of the children's organism characterised by deep damage of all types of metabolism, especially mineral metabolism, damaging of different organs and systems, inadequate or delayed mineralisation of bones and an excess of osteoid.

Etiology: A lack of vitamin D may arise because of 1) Insufficient endogenous synthesis; 2) A primary deficiency state due to a dietary lack of the nutrient; 3) Secondary deficiency caused by malapsorption of the lipid-soluble vitamin D (diseases of pancreas, billiard tract, intestinal diseases).

Pathogenesis: A deficiency of vitamin D induces not only abnormal serum levels of calcium and phosphate, but also secondary hyperparathyroidism and skeletal morphologic changers. It is now clear that vitamin D itself is not active in calcium metabolism. It must first conversion to its active metabolite which is essence constitutes a hormone since it is formed in the kidney and acts on distant target organs.

Clinical Symptoms Bone pain or tenderness (arms, legs, spine, pelvis) Increased tendency toward bone fractures Fever, especially at night Restlessness, especially at night weakness Decreased muscle tone (loss of muscle strength) Decreased muscle development Muscle cramps Impaired growth (short stature and slow growth)

Skeletal deformities: Bow legs Forward projection of the breastbone (pigeon chest) "Bumps" in the rib cage (rachitic rosary) Asymmetrical or odd-shaped skull Spine deformities (spine curves abnormally, including scolios or kyphosis) Pelvic deformities Dental deformities: Delayed formation of teeth Defects in the structure of teeth, holes in the enamel Painful teeth, aching aggravated by sweets, or by cold/hot food or drinks Increased incidence o cavities in the teeth (dental caries)

Diagnostic signs and tests Serum calcium and serum phosphorus may be low. Serum аlkaline phosphatase may be high. Arterial blood gases may reveal metabolic acidosis. Bone X-rays may show decalcification or changes in the shape or structure of the bones.

Classification of the rickets Classical Rickets or acquired, congenital, caused by vit D deficiency Levels of severity I – mild II – moderate III - severe

Disease Course character Acute Subacute Reccurent

Disease periods Beginning Development Recovering Remains changes

TREATMENT 1 STAGE VITAMINE D – VIDEIN – IU 1 TIME\DAY 30 DAYS 2 STAGE VITAMINE D – VIDEIN – IU 1 TIME\DAY 40 DAYS 3 STAGE VITAMINE D – VIDEIN – IU 1 TIME\DAY 45 DAYS THEN PROFILACTIC DOSE – 500 IU TILL THE END OF THE SECOND YEAR OF LIFE

SPECIFIC POSTNATAL PROFILACTIC HEALHU BABY IU TILL THE END OF THE SECOND YEAR OF LIFE PREMATURE BABY – FROM THE DAYS OF LIFE

1 STAGE OF PREMATURING VITAMINE D – VIDEIN – IU 1 TIME/DAY 6 MONTHS 2 STAGE OF PREMATURING VITAMINE D – VIDEIN – IU 1 TIME\DAY 6 MONTHS 3 STAGE OF PREMATURING VITAMINE D – VIDEIN – IU 1 TIME\DAY 6 MONTHS THEN PROFILACTIC DOSE – 2000 IU DURING 30 DAYS 2-3 TIME \YEAR WITH INTERVALES 3-4 MONTHS TILL 3-D YEAR OF LIFEAYTILL THE END OF THE SECOND YEAR OF LIFE