Focus
Vitamina D e rachitismo carenziale
Vitamin D deficiency rickets
Anna Agrusti1, Sarah Contorno1, Irene Bruno2, Giulia Gortani2, Egidio Barbi1,2
1Università di Trieste, 2IRCCS Materno-Infantile “Burlo Garofolo”, Trieste
Settembre 2020 - pagg. 426 -429 | DOI: 10.53126/MEB39426
Abstract
Mouhamed, a 7-year-old boy of African origin, presented with progressive fatigue and difficulty in walking. He was never treated with vitamin D supplementation. The evaluation of his calcium-phosphorus metabolism revealed a myopathy related to severe rickets. Therefore, he was treated with high-dose vitamin D3 and myopathy and fatigue progressively resolved. Vitamin D plays a crucial role in the calcium-phosphorus metabolism, by acting on enterocytes, osteoclasts and renal tubule. Vitamin D deficiency is defined when the 25OHD value is less than 20 ng/ml. In order to guarantee the assumption of the minimum daily dose of vitamin D, it is recommended to start vitamin D3 supplementation in all newborns and infants in their first year of life, regardless of the feeding modality. Exposure to the sun is essential for the activation of vitamin D, so dark-skinned children and mothers or those little exposed to the sun should start vitamin D3 supplementation. Vitamin D3 should also be supplemented in children with cerebral palsy and in patients treated with anti-epileptic drugs. Other conditions at risk of vitamin D deficiency are inflammatory bowel disease, celiac disease, cystic fibrosis, obesity, liver failure, cholestasis and vegetarian or vegan diets. Classic signs of rickets are the rickety rosary, the widening of the wrist and the arching of the tibia. Severe hypocalcaemia secondary to vitamin D deficiency can occur with dilated cardiomyopathy or convulsions, especially in dark-skinned infants. Vitamin D deficiency should be considered in children with progressive myopathy or muscular weakness, especially in dark-skinned ones or in those poorly exposed to the sun for cultural or religious reasons.
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Bibliografia
1. Fluss J, Kern I, de Coulon G, Gonzalez E, Chehade H. Vitamin D deficiency: a forgotten treatable cause of motor delay and proximal myopathy. Brain Dev 2014;36(1):84-7.
2. Baroncelli GI, Laccetta G, Giannoni A, Massei F. La medicina “magica” che ti mette in piedi. Medico e Bambino 2016;35:445-8.
3. Bischoff-Ferrari HA. Relevance of Vitamin D in muscle health. Rev Endocr Metab Disord 2012;13:71-7.
4. Ceglia L. Vitamin D and its role in skeletal muscle. Curr Opin Clin Nutr Metab Care 2009;12:628-33.
5. Brook CGD, Dattani MT. Handbook of clinical pediatric endocrinology. 2th Edition Wiley-Blackwell, 2012.
6. Saggese G, Vierucci F, Prodram F, et al. Vitamin D in pediatric age: consensus of the Italian Pediatric Society and the Italian Society of Preventive and Social Pediatrics, jointly with the Italian Federation of Pediatricians. Ital J Pediatr 2018;44:51.
7. Pedrosa C, Ferraria N, Limbert C, Lopes L. Hypovitaminosis D and severe hypocalcaemia: the rebirth of an old disease. BMJ Case Rep 2013.
8. Ahlawat R, Weinstein T, Petter MJ. Vitamin D in pediatric gastrointestinal disease. Curr Opin Pediatr 2017;29:122-7.
9. Carpenter T. Etiology and treatment of calcipenic rickets in children. UpToDate. UpToDate Inc. https://www.uptodate.com (accessed on March 17, 2019).
10. Bassanese S, Norbedo S. Quando dare la vitamina D. Medico e Bambino pagine elettroniche 2004;7.
11. Cadario F, Savastio S, Magnani C, et al. High prevalence of vitamin D deficiency in native versus migrant mothers and newborns in the North of Italy: a call to act with a stronger prevention program. PLoS One 2015;10: e0129586.
12. Deora V, Aylaward N, Sokoro AR, El-Matary W. Serum vitamins and minerals at diagnosis and follow-up in children with celiac disease. J Pediatr Gastroenterol Nutr 2017; 65:185-9.
13. Daley T, Hughan K, Rayas M, Kelly A, Tangpricha V. Vitamin D deficiency and its treatment in cystic fibrosis. J Cyst Fibros 2019;18 suppl 2:S66-S73.
14. Akpinar P. Vitamin D status of children with cerebral palsy: should vitamin D levels be checked in children with cerebral palsy? North Clin Istanb 2018;5:341-7.
15. Penagini F, Mameli C, Fabiano V, Brunetti B, Dilillo D, Zuccotti GV. Dietary intakes and nutritional issues in neurologically impaired children. Nutrients 2015;7:9400-15.
16. Pedrosa C, Ferraria N, Limbert C, Lopes L. Hypovitaminosis D and severe hypocalcaemia: the rebirth of an old disease. BMJ Case Rep 2013.
17. Ylmaz O, Kilic O, Ciftel M, Hakan N. Rapid response to treatment of heart failure resulting from hypocaclemic cardiomyopathy. Pediatr Emerg Care 2014;30:822-3.
18. Gupta P, Tomar M, Radhakrishnan S, Shrivastava S. Hypocalcemic cardiomyopathy presenting as a cardiogenic shock. Ann Pediatr Cardiol 2011;4:152-5.
19. Tomar M, Radhakrishnan S, Shrivastava S. Myocardial dysfunction due to hypocalcemia. Indian Pediatr 2010;47:781-3.
20. Ylmaz O, Olgun H, Ciftel M, et al. Dilated cardiopathy secondary to rickets-related hypocalcemia: eight case reports and a review of the literature. Cardiol Young 2015;25:261-6.
21. Kliegman RM, Stanton BF, St Geme JW, et al. Nelson Textbook of Pediatrics. 20th Edition, 2016, Elsevier.
22. Baroncelli GI, Vierucci F, Bertelloni S, Vanacore T, Vierucci G. Apporti consigliati di vitamina D: un “ritorno al passato”. Medico e Bambino 2010;29(4):237-45.
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