This document discusses vitamin D, including its functions, sources, daily requirements, deficiency, toxicity, and management. Some key points:
- Vitamin D promotes calcium absorption and is important for bone health. Deficiency can cause rickets in children and osteomalacia in adults.
- Good dietary sources include fatty fish, fish liver oils, eggs, and dairy. Sun exposure also enables vitamin D production.
- Recommended daily intake is 10-20 micrograms for adults. Deficiency is managed with high dose vitamin D supplementation. Toxicity risks include excessive intake.
2. OBJECTIVES
1) What is Vitamin D,
its functions, rich
sources and its daily
requirement?
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3. OBJECTIVES
2. What are the
diagnostic
features of
deficiency and its
management?
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4. What is vitamin D?
1. VITAMIN D was earlier referred to as
"fat-soluble factor Dโ.
2. The vitamin was also called "calciferol,"
since it was found to boost calcium
deposits in bone.
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5. What is vitamin D?
There are two basic types of vitamin D:
๏ขErgosterol is the basic building block of vitamin D
in plants.
2.17-dehydro-cholesterol is the basic building block
of vitamin D in humans.
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6. What is vitamin D?
When ultraviolet light
from the sun hits the
leaf of a plant,
ergosterol is
converted into
ergocalciferol, or
vitamin D2.
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7. What is vitamin D?
Both of these
substances -
ergocalciferol in
plants and
cholecalciferol in
humans - are usually
referred to as
"provitamin Dโ.
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9. Functions of Vitamin D
Intestine:
1. Promotes
absorption of
Calcium and
Phosphorus.
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10. Functions of Vitamin D
Bone:
Stimulates normal
mineralization.
Enhances bone resorption.
Affects collagen
maturation.
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11. Functions of Vitamin D
Kidney:
โข Increases tubular
resorption of
phosphate.
โข Variable effect on
calcium resorption.
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12. Functions of Vitamin D
Other:
Promotes
normal
growth.
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13. Food Sources
1. Fish
2. Liver
3. Oils
4. Egg yolk
5. Butter
6. Hen
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14. Impact of Cooking,
Storage and Processing
How do cooking, storage, or processing
affect vitamin D?
Vitamin D is a stable compound. Neither
cooking nor long-term storage significantly
reduce vitamin D levels in food.
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15. PREDISPOSING FACTORS
FOR DEFICIENCY
๏ข Breast feeding, if
the mother is
vitamin D deficient
๏ข Obesity
๏ข Insufficient dietary
fat or inability to
absorb dietary fat
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16. PREDISPOSING FACTORS
FOR DEFICIENCY
4. Health conditions that
involve the
parathyroid gland or
kidney.
5. Ageing
6. Genetic susceptibility
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17. Deficiency Symptoms
In addition, breast milk may not
contain a sufficient amount of
vitamin D so exclusively breast-
fed infants may require
supplemental vitamin D.
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18. Predisposing factors for Deficiency
Although vitamin D deficiency
is relatively rare, it is important
for individuals with limited sun
exposure to include good
sources of vitamin D in their
diets.
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19. Predisposing factors for Deficiency
1. Homebound
individuals.
2. People living in
northern latitudes.
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20. Predisposing factors for Deficiency
3. Individuals who
wear clothing that
completely
covers the body.
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21. Predisposing factors for Deficiency
4. Individuals
working in
occupations that
prevent exposure
to sunlight.
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22. Drug-Nutrient Interactions
The following medications
impact the absorption,
utilization and/or activation
of vitamin D:
Anticonvulsant medications,
including Dilantin,โฆ
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23. Drug-Nutrient Interactions
2) Cimetidine
3) HRT may blood levels of vit.D.
4) corticosteroids
5) Heparin
6) Bile acid sequestrants
(Cholestyramine, Colestipol)
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27. Age Prevention Tolerable Upper Limit Treatment
Premature
neonates
400 IU / day 1000 IU / day 1000 IU / day
Neonates (< 1
months)
Infants (1-12
months)
400 IU / day
400 IU / day
1000 IU / day
1000 โ 1500 IU/day
2000 IU/day
2000 IU/day
1 โ 18 years 600 IU/day
3000 IU day till 9
years
4000 IU/day from 9 โ
18 years
60000 IU weekly
for 6 weeks
At risk groups
400 โ 1000
IU/day
As per age group
As per age
group
TABLE I RECOMMENDATIONS FOR VITAMIN D DEFICIENCY โ
PREVENTION AND TREATMENT
IAP Guidelines: July 2017
28. Age Prevention Tolerable Upper Limit Treatment
Premature
neonates
150 - 220
mg/kg/day
1000 mg / day
175 โ 200 mg/kg/
day
Neonates (< 1
months)
Infants (1-12
months)
200 mg/day
250 - 500
mg/day
1000 mg / day
1000 โ 1500 mg/day
500 mg/day
500 mg/day
1 โ 18 years
600 - 800
mg/day
2500 mg/day till 8
years
3000 mg/day from 9 โ
18 years
600 - 800 mg/day
At risk groups
As per age
group
As per age group
As per age
group
TABLE II RECOMMENDATIONS FOR CALCIUM DEFICIENCY โ
PREVENTION AND TREATMENT
IAP Guidelines: July 2017
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Dietary sources of vitamin D
ยตg/100 g ยตg/100 g
Butter
Eggs
Milk; whole
Fish fat
0.5-1.5
1.25-1.5
0.1
5-30
Shark liver oil
Cod liver Oil
Halibut liver
oil
30-100
200-750
500-10 000
30. Health Conditions
What health conditions require special
emphasis on vitamin D?
๏ขAtherosclerosis
๏ขBreast cancer
๏ขDepression
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35. Deficiency Symptoms
In infants and children,
such a deficiency
manifests itself as rickets,
a condition characterized
by bone deformities and
growth retardation.
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36. Deficiency Symptoms
Adults with vitamin D
deficiency may
experience bone pain
and/or osteomalacia (soft
bone).
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37. CLINICAL FEATURES
OF VITAMIN D DEFICIENCY
๏ฑ Clinical manifestation of
RICKETS in children
usually manifest in the
latter half of the first year or
in second year.
๏ฑ Rickets is unusual below
the age of three months.
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38. EARLY SIGNS OF RICKETS
Increased sweating
over face and
forehead.
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46. CLINICAL FEATURES
10. Rachitic pelvis, resulting in
difficulty in normal delivery.
11. Epiphyses of long bones
widened.
12. Deformity of long bones.
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49. RADIOLOGICAL PICTURE
1. Early radiological
changes are
observed in lower
ends of radius and
ulna.
2. A cup or saucer like
depression is seen at
the growing end of
bone.
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50. RADIOLOGICAL PICTURE
3. Cupping and fraying
of the distal ends of
the radius and ulna.
4. Double contour along
the lateral outline of
the radius (Periosteal
Osteoid).
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51. RADIOLOGICAL PICTURE
5. Increase distance
between epiphysis
and ends of
metacarpals.
6. Greenstick fractures.
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52. BIOCHEMICAL FINDINGS
1. Decreased Serum Vit D
Levels.
2. Serum calcium may be
low or normal.
3. Alkaline phosphatase is
high (>500mg/dL)
4. Serum phosphorus is
low.
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53. MANAGEMENT
1. Administration of 15,000
micrograms or 600,000 I.U. of Vit.D
orally.
2. Wait for 4 weeks.
3. Look for ZPC (Zone of Proliferating
Calcification).
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54. RADIOLOGICAL FINDINGS
1. A) Active rickets
showing cupping &
fraying of distal ends
of radius & ulna.
1. B) Healing rickets
after 12 days of
treatment showing
ZPC.
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A B
55. RADIOLOGICAL FINDINGS
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1. C) Healing rickets after 18
days of treatment, ZPC
well defined.
2. Epiphysis of radius
becomes well calcified. C D
56. RADIOLOGICAL FINDINGS
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1. D) Healing rickets after
29 days of treatment.
2. ZPC,rachitic
metaphysis and shafts
have become united. C D
57. MANAGEMENT
1. If ZPC is not seen in X-ray within 3-4
weeks, repeat the dose of 6 lakh I.U.
2. Wait for another 4 weeks.
3. Look for ZPC.
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58. MANAGEMENT
1. Cases who respond to this
therapy are further put on 400
units or 10 micrograms of Vit.
D/day after healing has started.
2. Deformities of bones are
treated by orthopedic
measures.
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59. MANAGEMENT
๏ฑ If two massive doses of 6 lakh I.U. of Vit. D
does not result in production of ZPC, then it
is not a case of Nutritional Rickets.
๏ฑ It may be โVit. D Dependant Ricketsโ or
โVit. D Resistant Ricketsโ.
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60. MANAGEMENT
1. Child should be encouraged
to play outdoors.
1. Diet should be
supplemented by vit. D.
1. Steatorrhoea or
malabsorption of fat, when
present, should be treated.
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61. Toxicity Symptoms
Individual with hyperparathyroidism,
Overactivity of the parathyroid gland,
are at increased risk for vitamin D
toxicity, and should not take
supplemental vitamin D without
consulting a physician.
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62. Toxicity Symptoms
1. Excessive dietary intake of vitamin D can be
toxic. Symptoms include:
2. loss of appetite,
3. nausea,
4. vomiting,
5. high blood pressure,
6. kidney malfunction, and
7. failure to thrive.
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63. Management of Toxicity symptoms
PREVENTION: By
careful evaluation of
vitamin D dosage.
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64. Management of Toxicity symptoms
TREATMENT:
Discontinue Vit D intake.
Decrease intake of calcium.
For severely involved infants, aluminum hydroxide
by mouth, cortisone, or sodium versenate is used.
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65. Conclusion
1. Vitamin D acts as a double-edged sword.
2. Deficiency leads to rickets, while excess
results in metabolic bone disease.
3. Deficiency cannot be corrected by dietary
supplements; massive Vit. D dose is
required.
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66. 1). Richest source of Vit. D is โ
๏ข Shark liver oil
๏ข Cod liver oil
๏ข Halibut liver oil
๏ข Safflower oil
Ans.- 3
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67. ๏ฑ 2). All the following vitamins are
antioxidants except โ
1. Vit A
2. Vit C
3. Vit D
4. Vit E
Ans.- 3
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68. ๏ฑ 3). Which of the following vitamin is needed in
excess of normal daily requirement in
pregnancy? โ
1. Vitamin A
2. Vitamin D
3. Vitamin C
4. ALL of the above.
Ans. โ 4
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69. ๏ฑ 4). Which joint shows the best radiological
features of Rickets? โ
1. Knee.
2. Wrist.
3. Elbow.
4. All of the above.
Ans. โ 2
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70. ๏ฑ 5). Which of the following is the earliest
sign of Rickets? โ
1. Increased sweating on forehead and face.
2. Rachitic Rosary.
3. Rachitic pelvis.
4. Delayed closure of anterior fontanelle.
Ans. โ 1
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71. ๏ฑ 6). The dose of Vit. D in treatment of
Rickets is โ
1. 600 IU.
2. 6000 IU.
3. 60000 IU.
4. 600000 IU.
Ans. โ 4
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