Treatment of rickets

Treatment of rickets should be integrated with the mandatory inclusion of all non-specific events. Indication for therapeutic doses of vitamin D are validly expressed clinical and biochemical signs of vitamin D deficiency (craniotabes, symptom Lepskaya, hypophosphatemia, hypocalcemia, negative or slabopolozhitelnym trial of Sulkowice).
Demonstrative clinical symptoms of rickets, confirmed by biochemical, radiological studies are the basis for the purpose of therapeutic doses: I degree blooming rickets - 400 000 to 600 000, II degree - 600 000-800 000, III degree - 800 000-1000 000 ME. Daily doses of vitamin Dpri the rickets I make 10 000-15 000, with II-III degree - 20 000-30 000 ME for 20-30 days. The purpose of higher doses is not desirable because of the possibility of development of hypervitaminosis D.
In subacute during blooming of rickets, when dominated by the process osteodes hyperplasia (increase frontal, occipital Bugrov, changes in bone systems) and there are no symptoms softening of bones (craniotabes, symptom Lepskaya), appointed treatment-and-prophylactic doses of the vitamin. Such a period of rickets is usually not the result of hypovitaminosis D, as a consequence of other rakitovan reasons (poor feeding, hypovitaminosis A, group b, C, frequent pneumonia, acute respiratory infections and other). Therefore, such children should be appointed treatment-and-prophylactic doses of vitamin D, surpassing preventive 3-4 times, i.e. 4000-6000 ME a period of three weeks.
If in the dynamics of the observations noted reverse development of clinical (biochemical and x-ray), the indicated dose give another 3-4 weeks, then move on prevention. The basis for their use are pronounced clinical response to treatment, and the positive reaction of Sulkowice (+ + +) 2-3 studies urine.
In the absence of the effect of treatment must be closely examine the child to exclude E-vitaminiziruet, tubulopatii and-like diseases.
Currently, for the treatment and prevention of rickets is successfully used videin, which is a complex of vitamin D2 with protein. Advantages of videira is that it is resistant to the effects of different endogenous factors, convenient for dosage (Lukyanova and others, 1972). It is best to give videin with food, mixing the powder with 1 teaspoon of breast milk. To prevent rickets videin given month old Mature and 2 weeks premature on the treatment of 300 000 ME). In the treatment of rickets principles of prescribing it should be the same as in the treatment of this disease vitamin D.
It is necessary to emphasize the importance of the children of vitamins a, C, B1, B5, because in rickets often a polyhypovitaminosis. Complex use their improves metabolism, functional activity of the gastrointestinal tract.
To increase the effectiveness of vitamin D and avoidance D-vitamin toxicity to the appointment of vitamin a 1,600 ME oil solution 10-15 days. Sometimes after specific treatment of rickets vitamin D. there is a need to assign of course UV radiation (from about biodozy gradually increase to 2.5-3 biodoses). Only 20-25 sessions of exposure.
Fish oil is prescribed to children mainly after the completion of specific treatment. Preparations of calcium with vitamin D are given only to children who are breastfed, with displays of blooming rickets (5-10% solution of calcium chloride teaspoon 3 times a day or calcium gluconate 0.25-0.5 g three times).
Pathogenetically due to the use of citrate mixture (citric acid 8-10 g\ citrate sodium 6,0-8,0 g, water 100,0 ml) on a tea spoon 3-4 times a day for 10 to 12 days. Last improves calcium absorption in the intestine and reduce acidosis. The importance of massage and gymnastics, especially in the subacute period of the disease, they improve revolitionaries, normalize redox processes, and also have a tonic effect on the nervous system.
To improve muscle tone and restore a static functions in children under the age of one year applies neostigmine: 0.05% solution of 0.1 ml intramuscularly 10-12 days or in powder from 0.0001 up to 0,0003 three times a day.
Auxiliary methods of treatment of rickets are the salt bath and in children with reduced power and easily excitable - coniferous. Salt and coniferous baths are applied to children older than 6 months. For the salt baths in a bucket of water take 50 g of salt. Water temperature of 36° gradually reduced to 32 degrees, for children older than 1 year - up to 30 degrees. Duration baths 3-5 minutes, at the rate of 10-15 baths every other day. Coniferous baths: in a bucket of water is placed 0.5 table-spoon of coniferous extract, duration 5-10 minutes, at the rate of 15-20 baths.