临床医学佝偻病课件_1.ppt

Vitamin D roles Facilitate intestinal absorption of calcium and phosphorus Promote renal reabsorption of phosphorus Direct effect on bone deposition and reabsorption of calcium and phosphorus Maintain calcium and phosphorus homeostasis General manifestations: irritability, temporary teeth eruption delayed，anterior fontanel closure delayed Muscles lack of tone Head: craniotabes, Ping-Pong ball,caput quadratum Chest: beading of the ribs, pigeon breast deformity, Harrison groove Limb: Thickening of the wrists and ankles Bow-legs, knock-knees Biochemical changes Normal or low serum calcium Serum phosphorus level less than 4mg/dl Serum AKP level elevated Low serum 25-hydroxycholecalciferol Radiographic findings Active rickets: Distal ends, cupping and fraying of the radius and ulna Healing rickets: Zones of preparatory calcificaiton (ZPC); rachitic metaphysis calcification taken place Based on: a history of inadequate intake of vitamin D、inadequate exposure to sunlight Characteristic clinical signs of rickets. Confirmed by: Chemical and radiographic examination Differential Diagnosis Cretinism Chondrodystrophy Hydrocephalus Vitamin D-resistant Rickets Treatment Both natural and artificial light of the appropriate wavelength are effective therapeutically Oral adiministration of Vitamin D is preferred. 5,000-10,000IU/d; 300,000IU im; repeat one months later,if needed. Prevention Adequate exposure to ultraviolet light Oral administration of Vitamin D 400IU daily Hypervitaminosis D Excessive amounts of Vitamin D intake, usually develop after 1-3 mo of excessive intake Anorexia, irritability, constipation, polydipsia Chemical examination：Hypercalcemia and hypercalciuria radiographs: metastatic calcification and generalized osteopetrosis in long bone Treatment: discontinuing vitamin D intake and decreasing calcium intake 我劝一个草率结婚的朋友离婚。她平静的告诉我，如果说当初鲁莽结婚是个错误。那么，现在草率离婚是一错再错。这位朋友后来还是离婚了，大家一致认为她的行为很理性。同样的故事正在互联网搜