Rickets ?l&..

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It's a disease of growing child.

It's a syste1nic disease
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1- Diet
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N.B : Breast 1nilk are deficient source of Vit-D
2- Ultraviolet rays
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3- Vita1nin D supple1nents

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In the intestine: increases absortopn of Ca, P
In the kidney: increases reabsorption of Ca, P
In the bone: sti1nulate 1ninerlization of bone

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 YY Rickets .JI e_l;il '! ~
Nutritional Rickets Non Nutritional Rickets
Causes : YY '-:?ljl .:IJ~ Subgrouped into:
- Prolonged breast feeding Inherited Rickets :
- Fresh cow 1nilk feeding - hypophosphate1nic Vit D
- Unexposure to sun light Resistant rickets
- Hypocalce1nic Vit-D
Resistant rickets
- Renal Tubular Acidosin
Rickets with chronic disease:
- with Chronic 1nalabsorption
- with chronic liver disease
- with chronic Renal Disease

YY Rickets '! ~ ~
- It's a 1netabolic Disease - characterized by Defective
1ninerlization of bones
- Most of cases in developing countries are nutritional in
origin and 1nostly seen between age of 6 1nonth and 2
years, However non nutritional rickets should be
considered when : onset is too early ( below 6 1nonth ) ,
too late ( above 2 years) & when chronic disease is
conc01nitantly present.

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- Delayed 1notor develop1nent (sitting, standing, walking)
- Delayed Dentations (no teething till age of 12 1nonths)
- Bone Defonnities
- One of c01nplication as chest infection or tetany

Dietetic Hi story ) -
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A ]kaline phosphatase1~ p ~ -

Clinica] Pictun~o,f 8) (< :

1 - Skeletal Manifestations
A) Head : Large Head , Delayed closure of Anterior
Fontane!, Delayed Teething.

Q) What are the nonnal Anterior F ontanel ?

- Opened at birth
- it's size= inch x inch= 2.5 x 2.5 c1n
- Slightly Depressed
- pulsating but not tense
- dimnond shaped
- Close c01npletely at 1.5 year

Q) Significant of Anterior F ontanel ?

- Pulged in 7 increase Intracranial Tension
- Depressed in 7 Dehydration
- Early Closure 7 Craniostenosis , Microchephaly
- Delayed Closure 7 Rickets , Down , Hydrocephales ,
Ontogenesis i1nperfecta
- Cranial Sonar through the anterior fontanel.

B) Thorax:
- rosary Beads: enlarged Costo-chondral Junction
- longitudinal sulcus: vertical groove behind rosary beads
- Harrison sulcus: horizontal groove behind rosary beads
- Pigeon Chest .
C) Limbs:
- Broad epiphysis at lower end of ulna and Radius
- Marfan Sign : Transverse groove palpated over 1nedial
1nallelous

D) Spine : Correctable Rounded kyphosis

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In pott's Diease: Kyphosis is angular and not corrected
by extension of back

2- Muscular Manifestation:
Hypotonia of Skeletal , S1nooth 1nuscles 7 Delayed
Motor Develop1nent + abd01ninal distension

3- Neurological Manifestation :
Early case: Anorexia , Irritability and Sweating
Late case: Tetany .

Complications of Rickets :
- Green-Stick fracture .
- Tetany
- Recurrent Chest infection: Because of chest defonnity
and 1nuscle hypotonia which lead to weak cough reflex
and retention of secretions
Tetan
Nonnal sermn Ca= 9 - l l 1ng / dl
Seru1n Ionized Ca. shouldn't be below 1- 1.3 1ng / d

Manifest Tetany : Occur with seru1n Ca below 7 1ng / dl

- Carpo-Pedal Spas1n the 1nost c01n1non sign
( Carpo spas1n : Flexsion of the wrist , flexion of M.P
Joint, adduction of thu1nb) (Pedal Spas1n : Planter flexion
of ankle Joint and Toes)
- Laryngo-spas1n: Stridor and airway obstruction
- Convulsion : in sever cases

Latent Tetany:
Occur with seru1n Ca between 7 - 9 1ng / dl and needs

Provocation Test to catch latent tetany as :

Trousseau sign:
Constriction of upper ann with sphyg1no1nan01neter 7
Carpo spas1n
Peroneal Sign:
Tapping fibula over peroneal nerve 7 Pedal Spas1n
Chovstick sign:
Tapping of facial nerve 7 Facial contraction

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The 1naxi1nu1n dose : 15 cc whatever the weight
Another Opinion: 10 cc only

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:Rickets .JI [~
1- Diet :
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Phosphate -

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2-V it -D ' Ca :
Decal B , Pedical, V ita Cal syrp
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N on N u tr i t i on a] R 1ck et s
Exclusion J~ ~y:.l r..;j 3

Hyper-vitaminosis
- Anorexia , V 01niting
- Irritability
- Arryth1nia
- Renal Calcinonsis