Rickets diagnosis - vitamin D deficiency - children

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Visual observations supported by analytical, radiographic and differential methods confirm the diagnosis of rickets and deficiency of vitamin D in children.
Diagnosis of rickets by visual observations
Sleep pattern of the patient is observed. Affected children sleep poorly and are restless in the night. Their constant movements in the bed, may even cause the hair on their head to wear off. This is a clear sign of vitamin D deficiency and on set of rickets. There is every possibility of wrong interpretation of this sign of rickets as psychosis.
The growth pattern of the children are observed. The growth in the affected is slow and often retarded.
The affected persons will be slow in sitting up, crawling and walking.
The bones of the affected children may bend due to weight of the body and the joints may deform giving deformities like bowed leg and pigeon-breast; a clear diagnosis of vitamin D deficiency.
The muscles of the affected children will be weak and the patients will have pain and distress while moving.
Due to leaching of phosphorus and calcium the bone will be weakened and there can be a history of fractured bones indicating the deficiency of vitamin D.
The broadening and thickening of wrists and ankles is a clear sign of vitamin D deficiency.
The patients show frontal bossing and the forehead becomes prominent and square.
During dental examination, the affected children show delay in emergence of teeth, abnormal tooth structure and cavities.
Diagnosis of rickets by laboratory studies
Serum test and measurements of phosphorus, calcium, parathyroid hormone and alkaline phosphatase are taken for diagnosis of rickets.
In early disease the ionised fraction of calcium will be low, but may be within the reference range.
Serum phosphate will be lower than the reference range.
Parathyroid hormone will show increased values.
Serum calcidiol will show decreased values.
Serum alkaline phosphatase will be more than the reference values.
Levels of serum citrates will be less than 2.5 mg/dl.
Urine calcium will show decrease in levels.
Urine phosphates will show increase in levels.
Diagnosis of rickets by radiography
Radiographic study of long bones, ankles, wrist and knees is made.
In rickets affected children who are able to walk, the defective bone growth give a clear image of bent limbs.
Typical appearance of growth plates with lack of normalcy in mineralisation of the cartilages is seen.
Fraying (irregularity and widening) of the growth plate is seen in radiography.
The metaphysis show concavity (cupping) and the metaphyseal end of bone shows splaying (widening).
Differential diagnosis
Excluding the related signs help. Severe deficiency of calcium and phosphorus can show the symptoms.
Diagnosis to be done to exclude Hypophosphatasia, a rare metabolic bone disease, with confusing symptoms similar to rickets.
A form of short limbed dwarfism, Jansen syndrome may also show metaphyseal chondroplasia.
Hereditary vitamin D -resistant rickets has to be differentiated.

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