34 HYPOVITAMINS IN CHILDREN
Endesh kyzy gulsara, lecturer, International medical faculty, osh state university, department : pediatrics
Jayaprakash mohan manoj, student, International medical faculty, osh state university
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ABSTRACT :
Today, vitamin D deficiency is regarded as a pandemic. The main cause of vitamin D deficiency is the general underestimation of the amount of vitamin D that most people obtain from moderate sun exposure. Vitamin D, which is fat-soluble, is necessary for calcium homeostasis and bone metabolism. An insufficient amount of vitamin D can result in osteomalacia and rickets in children and osteomalacia in adults. Low vitamin D has been associated with a higher risk of common cancers, autoimmune diseases, infectious diseases, and high blood pressure. A circulating level of 25-hydroxyvitamin D must be higher than 75 nmol/L, or 30 ng/mL, in order to maximize the health benefits of vitamin D.
KEYWORDS : Vitamin D deficiency, Sun exposure, Calcium homeostasis, Osteomalacia/Rickets, Health benefits, 25-hydroxyvitamin D (or Circulating level).
INTRODUCTION :
Vitamin D is one of the most important fat-soluble vitamins for healthy body growth and development. Sunlight is the primary source of vitamin D in the human body. Numerous studies indicate that vitamin D deficiency is more common in the winter and spring than in the fall and summer in the United States.Vitamin D deficiency was found to be common in healthy Tehran children, with females being more affected than boys (1,2). Inadequate exposure to sunlight, malabsorption, the rapid breakdown of some medications, and the low levels of vitamin D in breast milk in infants can all lead to vitamin D deficiency.Beyond calcium absorption and bone maintenance (3,4), vitamin D (cholecalciferol) has a number of significant physiological effects. Also, early vitamin D replenishment through supervised supplementation may improve immune function (7,8) ,chronic disease risk (9,10) , and neurologic health(5,6) later on.One of the strong antioxidant, vitamin D helps prevent the development of cancer. Therefore, a number of diseases are at risk due to hypovitaminosis D (11)
ETIOLOGY :
Numerous factors can lead to vitamin D deficiency, which may interfere with one or more phases of vitamin D activation. The most crucial elements are as follows:
Reduced sun exposure: To avoid vitamin D deficiency, one must receive approximately 20 minutes of sunshine per day, with more than 40% of the skin exposed.
(20)
Higher hepatic catabolism: Drugs like rifampin, phenobarbital, carbamazepine, dexamethasone, nifedipine, spironolactone, clotrimazole, and phenobarbital cause the liver's p450 enzymes to be activated, which speeds up the breakdown of vitamin D into inactive metabolites.(19)
Rickets or osteomalacia can occur in people with chronic kidney disease due to decreased renal production of 1,25-dihydroxyvitamin D and elevated phosphate levels.
RECOMMENDED LEVEL :
For children under 12 months of age, 400 international units (IU) of vitamin D should be consumed daily; for those between the ages of 1 and 70, the recommended amount is 600 IU; and for those over 70, it is 800 IU.
SIGNS AND SYMPTOMS :
The majority of vitamin D deficient individuals show no symptoms.
Possible signs and symptoms include:
Pain in the muscles
Bone aches
An elevated level of pain sensitivity.
A "pins-and-needles" tingling feeling in the hands or feet.
Weakness of the muscles in the upper arms or thighs, which are located close to the body's trunk.
Pale skin
Fatigue
Lack of sleep
Depressive or melancholy states
The loss of hair
Slow healing of wounds
Dental issues
Hypertension, or elevated blood pressure.
Vitamin D deficiency in kids can cause lethargy, irritability, developmental delays, bone abnormalities, and fractures.
RISK FACTORS :
The following risk factors increase a person's likelihood of developing vitamin D deficiency:
Vegan diets: Dietary sources of vitamin D include animal products like vitamin D-fortified milk and fatty fish. Dieters who consume veganism are much more likely to have vitamin D deficiencies. (10)
Medical conditions: Liver and kidney failure, as well as conditions like celiac disease, IBD, and cystic fibrosis, can affect the body's ability to absorb vitamin D.
A higher risk of chronic illnesses, such as autoimmune disorders and cardiovascular disease, is linked to long-term deficiencies.
Vitamin D deficiency increases the risk of fractures by causing bone diseases like osteoporosis and osteomalacia.
DIAGNOSIS :
Based on the history and physical examination :
children with craniotabes may benefit from vitamin D status assessment and syphilis serologic testing; however, the majority of craniotabes cases resolve on their own
Clinically :
seizures from other causes may be indistinguishable from tetany caused by infantile rickets. Clinical history and blood tests may aid in their differentiation.
chondrodystrophy is characterized by a large head, short extremities, thick bones, and normal serum levels of calcium, phosphate, and alkaline phosphatase, it can be differentiated from rickets.
Radiographs :
Radiographs show changes in the bones before any clinical symptoms appear. The lower ends of the radius and ulna show the most noticeable changes in rickets. Instead of having a distinct, sharp outline, the diaphyseal ends become cup-shaped and exhibit a fringy or spotty rarefaction.
Laboratory tests :
In type I hereditary vitamin D-dependent rickets, serum phosphate levels are either normal or low, serum calcium and 1,25-dihydroxyvitamin D levels are low, and serum 25(OH)D.
Levels of hypervitaminosis D that are higher than 150 ng/mL are toxic.(18)
MANAGEMENT :
It is recommended that children who are
vitamin D deficient receive 2,000 IU of vitamin D3 per day or 50,000 IU once a week for six weeks.
The American Academy of Pediatrics recommends that children who are breastfed and those who drink less than one liter of vitamin D-fortified milk per day receive 400 IU of vitamin D supplements.(12)
Patients with severe hepatic dysfunction may be candidates for calcidiol, a major circulating metabolite of cholecalciferol, since it does not need to be activated by the liver's 25-hydroxylase. A dose of 30 to 200 μg per day is advised.(13)
Calcitriol is the recommended treatment for people with advanced kidney failure or hypoparathyroidism because it doesn't require activation by the kidney's 1α-hydroxylase. (14)
Maintenance dosages of 800–1,000 IU of cholecalciferol per day from dietary and supplemental sources should be started once vitamin D levels have returned to normal.(15,16)
A daily dose of 700–800 IU of vitamin D decreased the relative risk of hip fracture by 26% and the relative risk of nonvertebral fracture by 23% when compared to either a placebo or calcium supplementation alone. There was no discernible improvement in fracture prevention at 400 IU daily.(17)
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