Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
Other diagnostic factors
- dor óssea
- deficit de crescimento
- realização tardia de marcos motores
- deformidades ósseas
- fraqueza muscular
- espasmo carpopedal
- dormência ou parestesias
- tetania
- convulsões hipocalcêmicas
Risk factors
- de 6 a 23 meses de idade
- exposição inadequada à luz solar
- aleitamento materno
- peles mais escuras
- deficiência de cálcio
- deficiência de fosfato
- história familiar de raquitismo
- antiácidos, diuréticos de alça, corticosteroides ou anticonvulsivantes
Diagnostic tests
1st tests to order
- radiografia de um osso longo
- cálcio sérico
- fósforo inorgânico sérico
- nível sérico de paratormônio
- níveis de 25-hidroxivitamina D (calcidiol)
- fosfatase alcalina e testes da função hepática
- creatinina sérica e ureia
- cálcio urinário e fósforo
Tests to consider
- níveis de 1,25-di-hidroxivitamina D (calcitriol)
Treatment algorithm
hipocalcemia sintomática
raquitismo por deficiência de cálcio: deficiência de vitamina D
raquitismo por deficiência de cálcio: deficiência de cálcio
raquitismo por deficiência de cálcio: deficiência de pseudovitamina D
raquitismo por deficiência de cálcio: resistência à vitamina D
raquitismo hipofosfatêmico: ligado ao cromossomo X
raquitismo hipofosfatêmico hereditário com hipercalciúria
raquitismo hipofosfatêmico: induzido por tumor
Contributors
Authors
Carlos Palacio, MD, MPH, FACP
Professor of Medicine
Associate Program Director
Internal Medicine Residency
Department of Medicine
University of Florida College of Medicine
Jacksonville
FL
Disclosures
CP declares that he has no competing interests.
Firas Warda, MD
Endocrinology Fellow
Division of Endocrinology, Diabetes, and Metabolism
Department of Medicine
University of Florida College of Medicine
Jacksonville
FL
Disclosures
FW declares that he has no competing interests.
Acknowledgements
Professor Carols Palacio and Dr Firas Warda would like to gratefully acknowledge Dr Robert Olney, a previous contributor to this topic.
Disclosures
RO declares that he has no competing interests.
Peer reviewers
Phil Fischer, MD
Professor of Pediatrics
Mayo Clinic
Rochester
MN
Disclosures
PF declares that he has no competing interests.
Zulf Mughal, MD
Consultant in Paediatric Bone Disorders
Department of Paediatric Endocrinology
Royal Manchester Children's Hospital
UK
Disclosures
No disclosures
Arshag Mooradian, MD
Professor of Medicine
University of Florida College of Medicine
Jacksonville
FL
Disclosures
AM declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
American College of Obstetricians and Gynecologists. ACOG committee opinion no. 495: vitamin D: screening and supplementation during pregnancy. Jul 2011 [internet publication].Full text
Munns CF, Shaw N, Kiely M, et al. Global consensus recommendations on prevention and management of nutritional rickets. J Clin Endocrinol Metab. 2016 Feb;101(2):394-415.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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