Rickets(Nutritional)

Clinical Feature:

• 1)Short statures
• 2)Box like square head,hot cross bun appearance skull
• 3)Craniotabes 
• 4)Delayed closure of fontanel 
• 5)Delayed dentition
• 6)Pigeon chest 
• 7)Painless Rickitic rosary 
• 8)Harrison sulcus 
• 9)Scoliosis,kyphosis, lordosis 
• 10)Vulgas & varus deformity

Investigations: 

• 1)X-ray upper & lower limb including knee,ankle, elbow& wrist... Findings 
• wedning,cupping& fraying of metaphysis 
• Wide gab Between epiphysis & metaphysis 
• Green stick fracture 
• 2)Serum Calcium :. Low 
• 3)Serum phosphorus : low 
• 4)serum alkaline phosphatase: high 
• 5)Serum PTH: high 
• 6)Serum cretinine 
• 7) serun,electrolyte 
• 8)urine RME 
• 10)CBC

Rx: 

• Diet: Vitamin D contain diet 

Stoss therapy:  

3-6 lac IU vitamin D3(cholecalciferol) given orally

OR

• I/M 2-4 dose  within one day (একদিনে ভিতর। )

OR

• Gradual therapy : 2000-5000 IU /day... 4-6 weeks 

Then 

Maintance dose: 

• < 1 year child: 400 IU /day 
• > 1 year child:  600 IU/day 

2. Fund-3 (vitaminD)/osteo-D

• 4-6 drop daily.....1 month 

Advice: 

• 1) followup after 1 month with repeat x-ray
• 2) Vitamin D & calcium containing Diet 

➡️prognosis: very good