Snap Shot A child is known to have hypophosphatemia. On PE the child has bowing of the lower extremities and short stature. It is noted that he has a waddling gait. Deficiency Cause lack of sunlight and lack of dietary intake rare in developed countries due to food supplementation and styles that expose people to the sun Presentation osteomalacia is caused by Vitamin D deficiency in adults mimic osteoporosis rickets is caused by Vitamin D Deficiency in children craniotabes (thinning of skull bones) rachiticrosaey (costochondral thickening looks like string of beads) harrison's groove (depression along line of diaphragmatic insertion into rib cage) pigeon breast (pectus carinatum) bowing of legs is most common presentation waddling gait and short stature Evaluation labs low Vitamin D level calcium levels in the blood are normal imaging diagnosed by X-ray which shows radiolucency in combination with low Vitamin D level Excess Causes supplementation > 10x RDA seen in sarcoidosis ↑ activation of vitamin D by epithelioid macrophages Presentation polyuria, polydipsia, nocturia hypercalcemia, hypercalciuria high blood calcium concentration promotes metastatic calcification loss of appetite, stupor high levels of vitamin D promote bone resorption