佝偻病+手足抽搐症9.pptVIP

Mellanby Edward(1918) “ no more campaign on rickets” etiology etiology etiology etiology etiology 8-month-old female child Exclusively breast-fed without vitamin supplement The mother did not receive any vitamins or calcium Presented with irritation and night sweating for 4 months Physical examination showed pulvinar bald(枕秃), cephalus quadratus（方颅）, without primary teeth erupion. Clinical diagnosis ? Question 1 Why？ Question 2 Why is that? Question 3: If in progress? If not recognized and properly treated, vitamin D deficiency may cause pain, fractures, skeletal deformity, growth retardation, dental defects, delayed developmental milestones and, in severe cases, hypocalcemic tetany and seizures. Prematurity craniotabes pigeon breast harrison groove “X”form leg、“O” form leg rachitic rosary cephalus quadratus rachitic Thorax（胸部,6~12months） Extremity（四肢,1yr） Labs Calcium :＜2 (2.25 ～ 2.75mmol/L ) Phosphorus :＜ 1 (1.3 ～ 2.3mmol/L) 〔Ca〕×〔P〕:＜ 35 (35 ～ 45mg/dL) PTH :＞ 10 （1～10pmol/L） AKP:＞ 240（50～240U /L) Sweating Irritation Serum 25-(OH)D level is decreased(20ng/mL)* Differential diagnosis General consideration Tetany of vitamin D deficiency occurs most frequently under the ages of 6 month. Clinical manifestations Latent tetany No symptoms Positive signs — Chvostek — Trousseau — Peroneal reflex serum calcium lever is less than 1.75-1.88mmol/L Figure: Carpopedal spasm diagnosis Differential diagnosis Convulsion without fever hypomagnesemia Hypoparathyroidism Hypoglycemia Infantile spasms Case 1 病例分析：假设同学们在急诊室值班，一个6个月的婴儿，因为抽搐急诊入院，请问你如何进行抽搐查因的分析？如何进行诊治。 （5分钟分组讨论，5分钟陈述观点） treatment Emergency treatment Basic life support (establish airway, oxygen inhalation and mechanical ventilation) Anticonvulsant and control laryngospasm Calcium supplementation Others : Administration of VitD Treatment Biochemistry Calcium and phosphorus AKP PTH 25(OH)VitD Alteration of bones Rad