八年制讲课佝偻病.ppt

1、Rickets of Vitamin D Deficiency Tetany of Vitamin D Deficiency,Chen Qiuli Attending Doctor Pediatric department The first affiliated hospital of Sun Yat-sen University,Rickets, subsequent failure of capillary penetration occurs in a patchy manner(Fig),enlarged costochondral junction,*Non-calcified,

2、hypertrophied growth plate in rickets (R), compared to a normal growth plate (L).,Pathology,Disturbance of sclerotic calcification osteomalacia （骨质软化） osteoid deposition(骨样组织堆积), VitD 800U/d; diet rich in Ca, P, VitD Infant exposure to ultraviolet light daily VitD and Ca supplementation Term infant

3、VitD 400 U/d(2w2yr) premature infants VitD 800 U/d(2w3m), 400 U/d(3m2yr) *summer !,Prevention,& Rickets of Vitamin D Deficiency Introduction Physiological function and regulation of VitD Etiology Pathology Pathogenesis Clinical manifestations Diagnosis Differential diagnosis Prevention Treatment &Te

4、tany of VitD Deficiency,To control the progressive stage prevent osseous deformity Natural and artificial light Nutrition VitD analogue administration Prevent and treat complication,Treatment,VitD analogue administration Orally VitD 2,0004,000 IU/d 24 W 1,25(OH)2D3 0.5 2 g/d 24 W then VitD 400 IU/d

5、(10ug/d) Single dose im VitD3 200,000-300,000 IU 2-3m later VitD 400 IU/d reevaluation q1m,Treatment,& Rickets of Vitamin D Deficiency & Tetany of VitD Deficiency Introduction Chemical Pathology Prediposing factor Clinical manifestations Diagnosis & Differential diagnosis Treatment,Rachitic tetany I

6、ncidental age 6m(4m-3yr) Form of plasma Ca,810%,40%,4550%,IONIZED active form PH、serum P BOUND protein COMPLEXED,& Rickets of Vitamin D Deficiency & Tetany of VitD Deficiency Introduction Chemical Pathology Prediposing factor Clinical manifestations Diagnosis & Differential diagnosis Treatment,VitD

7、deficiency Ca, P absorption from the intestine serum Ca level parathyroid gland P reabsorption PTH PTH in the kidney mobilization of Ca ,P from the bone serum Ca serum P serum Ca, tetany CaPin ECF failure in mineralization of osteoid tissue and cartilaginous matrix rickets Pathogenesis,serum Ca2+0.7

8、51mmol/L serum Ca1.751.88mmol/L the loss of the inhibitory control that Ca exert on the neuromuscular junctions muscular irritability,Chemical Pathology,& Rickets of Vitamin D Deficiency & Tetany of VitD Deficiency Introduction Chemical Pathology Prediposing factor Clinical manifestations Diagnosis

9、& Differential diagnosis Treatment,VitD deficiency accompany with dull parathyroid response Relative Ca deficiency *enough exposure to sunlight (spring, summer) or VitD administration *concomitant inadequate Ca absortion from the intestine Pathological condition fever, infection, neonatal asphyxia,

10、high P level diet,Prediposing factor,& Rickets of Vitamin D Deficiency & Tetany of VitD Deficiency Introduction Chemical Pathology Prediposing factor Clinical manifestations Diagnosis & Differential diagnosis Treatment,Clinical manifestations,tetany and concurrent rickets Manifest Tetany (serum Ca2+

11、0.75mmol/L serum Ca1.75mmol/L) latent tetany (0.75 serum Ca2+ 1mmol/L 1.75 serum Ca 1.88mmol/L),Manifest Tetany Convulsions brief but recurrent, afebrile conscious between seizures Laryngospasm inspiratory obstruction high-pitched inspiratory crow apnea Carpopedal spasm (Fig ),Clinical manifestation

12、s,Fig. Carpopedal spasm,The wrist are flexed, the finger extended, the thumbs adducted over the palms, the feet extended and adducted.,latent tetany symptoms are not evident, but can be elicited by ischemia or mechanical or electrical Chvostek sign, Peroneal sign, Trousseau sign,stimulation of motor

13、 nerves,Clinical manifestations,Latent tetany,Chvostek sign facial spasm tapping anterior to external auditory meatus 7th(facial) cranial nerve Contraction of the orbicularis oris occurs with a twitch of the upperlip or entire mouth Peroneal sign pedal spasm tapping the head of fibula peroneal nerve

14、 dorsiflexion and abduction of the foot,Latent tetany,Trousseau sign carpospasm A blood pressure cuff on the arm is inflated above the systolic blood pressure for 5 min Ischemia of motor nerves by reducing the blood supply Carpospasm,& Rickets of Vitamin D Deficiency & Tetany of VitD Deficiency Intr

15、oduction Chemical Pathology Prediposing factor Clinical manifestations Diagnosis & Differential diagnosis Treatment,bases on Clinical manifestations manifest tetany, latent tetany Biochemical changes serum Ca2+0.751mmol/L serum Ca1.751.88mmol/L The combined presence of rickets,Dagnosis,Afebrile conv

16、ulsion Hypoglycemia (Glu) Hypomagnesemia (Mg) Infantile spasms Primary hypoparathyroidism(P) Infection of central nervous svstem acute laryngitis,Differential diagnosis,Prognosis good unless treatment is delayed, death rarely occurs (may result from laryngospasm and cardiac dilation) Prevention identical to that of VitD deficient rickets,& Rickets of Vitamin D Deficiency & Tetany of VitD Deficiency Introduction Chemical Pathology Prediposing factor Clinical manifestations Diagnosis & Differential diagnosis Treatment,Anticonvulsive treatment oxygen inhalation drugs 10% Chloral hydrat