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Updated: Apr 25 2017

Vitamin D

  • 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
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