Vitamin D deficiency
1. Big picture
Vitamin D deficiency in children is important because it affects calcium-phosphate metabolism and bone mineralization. The classical pediatric disease is nutritional rickets, especially in rapidly growing infants and toddlers.
For the exam, the examiner wants you to recognize this pattern:
Breastfed infant / dark skin / little sunlight / poor vitamin D intake → delayed motor milestones, sweating/irritability, craniotabes, widened wrists, rachitic rosary, bowed legs → low 25-hydroxyvitamin D, high alkaline phosphatase, secondary hyperparathyroidism → vitamin D + calcium treatment.
The dangerous acute presentation is hypocalcemic tetany or seizure, especially in infants.
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