Vit D Def
Vitamin D is important for good health, growth and strong bones. A lack of vitamin D is very common which can lead to osteomalacia in adults and rickets in children.
What is Vitamin D?
Vitamin D is an important vitamin for growth and strong bones.
What is the common source of Vitamin D?
The main source of this vitamin is exposure to sunlight. Lack of this vitamin leads to symptoms of tiredness and generalized body aches and if severe, then this can lead to rickets (in children) and osteomalacia (in adults).
How is Vitamin D made in the body?
Vitamin D is made in the skin by the action of sunlight. Food on the other hand contain very little of this vitamin. Foods that contain vitamin D include:
- Oily fish (such as sardines, pilchards, herring, trout, tuna, salmon and mackerel).
- Fortified foods (this means they have vitamin D added to them) such as margarine, some cereals, infant formula milk.
- Egg yolk, liver, and wild mushrooms contain only small quantities of vitamin D.
Ultraviolet B (UVB) rays in sunlight convert cholesterol in the skin into vitamin D. For a fair-skinned person, it is estimated that around 5-10 minutes of sunlight on the face and forearms around the middle of the day 2-3 times a week is sufficient to make enough vitamin D in the summer months in the India. However, for people with darker skin and the elderly, the amount of time needed exposed to sunlight to make enough vitamin D can be much more than this. It’s important that sunlight has to falls directly on to bare skin (through a window is not enough).
Why is Vitamin D so important?
The reason Vitamin D is so important is that it helps calcium and phosphorus in our diet to be absorbed from the gut. Which are then needed to keep bones healthy.
What do you understand by Vitamin D deficiency?
Vitamin D deficiency means that there is not enough vitamin D in your body. This can occur in three situations:
- The body has an increased need for vitamin D, like in growing children, pregnant or breast-feeding women.
- The body is unable to make enough vitamin D, example people living in places with little sunlight, or people who stay inside a lot, or people who cover up lot of their body when outside, like a niqab/ burqa.Elderly people generally have thinner skin, not enough to produce Vitamin D and so are more at risk of developing vitamin D deficiency. People who have darker skin are again at risk of developing Vitamin D deficiency. Diseases like Crohn's disease, coeliac disease, and some types of liver and kidney disease, all produce vitamin D deficiency
- Not enough vitamin D is being taken in the diet like people who are strict vegetarian or vegan diet, or a non-fish-eating diet.
What is the presentation of Vitamin Defieciency?
Many people are symptomless, or will have vague complaints of tiredness or general aches. As symptoms are often very nonspecific, problem is often missed. The diagnosis is easily reached in severe deficiencies with some of the classical (typical) symptoms and bone deformities.
Babies can get muscle spasms (cramps), seizures and breathing difficulties, which are associated with low levels of calcium. Children with severe deficiency may have soft skull or leg bones. Their legs may look curved (bow-legged). They complain of bone pains, often in the legs, and muscle pains or muscle weakness. This condition is known as rickets. Poor growth. Height is usually affected more than weight.
Affected children might be reluctant to start walking. Children with vitamin D deficiency have late teething are Irritable and prone to infections. They have a weak chest muscles and a soft rib cage leading to breathing problems. When severe, because of low calcium can lead to muscle spasms (cramps), seizures and breathing difficulties. These need urgent hospital treatment. Rarely, an extremely low vitamin D level can cause weakness of the heart muscle (cardiomyopathy).
In adults general tiredness, vague aches and pains and a general sense of not being well are the common symptoms. In more severe deficiency (known as osteomalacia), there may be more severe pain and also weakness. Bones can feel painful to moderate pressure (often more noticeable in the ribs or shin bones).
How do you diagnose Vitamin D deficiency?
Diagnosis as described is suspected from a good medical history, symptoms, or lifestyle. Blood test for checking vitamin D level can make the diagnosis. Sometimes, a wrist X-ray is done in a child to assess how severe the problem is by looking for changes in the wrist bones.
How do you treat Vitamin D deficiency?
The treatment is to take vitamin D supplements in form of vitamin D called ergocalciferol or calciferol. They can be given as an injection or as a medicine (liquid or tablets). A single injection of vitamin D, last for about six months. It is an effective treatment for people who don’t like to take medicines. High dose vitamin D is available at different strengths and a dose may be taken either daily, weekly or monthly.
The advantage of the higher-dose treatment is that the deficiency improves quickly - important in growing children. Standard-dose vitamin D can be taken every day for about 12 months so that the body can catch up on the missing vitamin D. This is a slow method of replacing vitamin D, but is suitable if the deficiency is mild, or for prevention. After vitamin D deficiency has been treated, the body's stores of vitamin D have been replenished. After this, maintenance treatment is often needed long-term, to prevent further deficiency in the future.
This is because it is unlikely that any risk factor for vitamin D deficiency in the first place will have completely resolved. The dose needed for maintenance may be lower than that needed to treat the deficiency.
How do you prevent Vitamin D deficiency?
Preventing vitamin D deficiency involves finding out the population who are more prone to this deficiency and targeting them accordingly. All pregnant and breast-feeding women should be given a daily supplement of 10 micrograms of vitamin D. All infants (babies) and young children aged 6 months to 5 years should take a daily supplement containing vitamin D in the form of vitamin drops. However, those infants who are fed infant formula will not need vitamin drops until they are receiving less than 500ml of infant formula a day, as these products are fortified with vitamin D.
Breast-fed infants may need to receive drops containing vitamin D from one month of age if their mother has not taken vitamin D supplements throughout pregnancy. People aged 65 years and over and people who are not exposed to much sun should also take a daily supplement containing 10 micrograms of vitamin D. In addition a doctor may advise routine vitamin D supplements for people with certain gut, kidney or liver diseases, and people prescribed certain medicines, and to certain people with darker skin.
Cautions when taking vitamin D supplements is needed in patients who are taking certain other medicines like digoxin (for an irregular heartbeat - atrial fibrillation) or thiazide diuretics such as bendroflumethiazide (commonly used to treat high blood pressure). In this situation, avoid high doses of vitamin D, and digoxin will need monitoring more closely. People who have other medical conditions: kidney stones, some types of kidney disease, liver disease or hormonal disease. Specialist advice may be needed. Vitamin D should be avoided by people who have high calcium levels or certain types of cancer. You may need more than the usual dose if taking certain medicines which interfere with vitamin D. These include: carbamazepine, phenytoin, primidone, barbiturates and some medicines for the treatment of HIV infection.
What are the side effects of taking Vitamin D deficiency?
Side effects of vitamin D is quite unusual. But if taken in very high doses it can raise calcium levels in the blood and this causes excessive thirst, passing a lot of urine, nausea or vomiting, dizziness and headaches. One should see the physician If you have these symptoms occur.
How do the patients fare?
The outlook is usually excellent. Both the vitamin levels and the symptoms generally respond well to treatment. However, it can take time (months) for bones to recover and symptoms such as pain to get better or improve.
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