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Ostali oblici rahitisa
Domina Petrić
Rahitis zbog malapsorpcije
• U djece s malapsorpcijskim sindromom
(npr. celijakija, cistična fibroza) se
može razviti rahitis ili, nakon prestanka
rasta, osteomalacija zbog
malapsorpcije vitamina D i kalcija (Ca).
• Zbog usporenog rasta potrebe za
vitaminom D i Ca u te djece su
smanjene pa je pojava težeg rahitisa
rijetka.
Rahitis zbog malapsorpcije
• Za prevenciju i terapiju rahitisa, osobito
u fazi oporavka, treba toj djeci davati
preparate vitamina D
parenteralno (50 000 i.j. im.
jednom mjesečno).
Rahitis zbog bolesti jetre
• U djece s intrahepatično ili
ekstrahepatično uzrokovanom
kolestazom postoji malapsorpcija
masti i u mastima topljivih
vitamina, pa i vitamina D, zbog
nedostatka žučnih kiselina u crijevu.
• Liječenje se provodi davanjem
pripravka kalcitriola 200 ng/kg/dan
peroralno.
Rahitis zbog antikonvulzivnih
lijekova
• Djeca koja dugotrajno uzimaju
antikonvulzivne lijekove imaju u
prosjeku nižu konc. Ca i višu
aktivnost ALP u serumu.
• Imaju u većem postotku blage
koštane znakove rahitisa na
kosturu u usporedbi s kontrolnom
skupinom djece.
Rahitis zbog antikonvulzivnih
lijekova
• Antikonvulzivni lijekovi aktivacijom
mikrosomnih enzima jetre ubrzavaju
razgradnju kolesterola i
25-hidroksikalciferola na inaktivne
razgradne produkte.
• Zbog toga je konc. 25-hidroksikalciferola u
serumu te djece snižena.
Rahitis zbog antikonvulzivnih
lijekova
• Barbiturati i difenilhidantoinati
imaju specifično inhibitorno djelovanje
na resorpciju Ca iz crijeva.
• Djeci na dugotrajnoj antikonvulzivnoj
terapiji treba davati dodatnih 400 i.j.
kalciferola/dan uz redovitih 400 i.j.
u obliku prikladnog farmaceutskog
pripravka.
• Literatura:
Duško Mardešić i suradnici.
Pedijatrija
Školska knjiga,
Zagreb, 2003.

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Ostali oblici rahitisa

  • 2. Rahitis zbog malapsorpcije • U djece s malapsorpcijskim sindromom (npr. celijakija, cistična fibroza) se može razviti rahitis ili, nakon prestanka rasta, osteomalacija zbog malapsorpcije vitamina D i kalcija (Ca). • Zbog usporenog rasta potrebe za vitaminom D i Ca u te djece su smanjene pa je pojava težeg rahitisa rijetka.
  • 3. Rahitis zbog malapsorpcije • Za prevenciju i terapiju rahitisa, osobito u fazi oporavka, treba toj djeci davati preparate vitamina D parenteralno (50 000 i.j. im. jednom mjesečno).
  • 4. Rahitis zbog bolesti jetre • U djece s intrahepatično ili ekstrahepatično uzrokovanom kolestazom postoji malapsorpcija masti i u mastima topljivih vitamina, pa i vitamina D, zbog nedostatka žučnih kiselina u crijevu. • Liječenje se provodi davanjem pripravka kalcitriola 200 ng/kg/dan peroralno.
  • 5. Rahitis zbog antikonvulzivnih lijekova • Djeca koja dugotrajno uzimaju antikonvulzivne lijekove imaju u prosjeku nižu konc. Ca i višu aktivnost ALP u serumu. • Imaju u većem postotku blage koštane znakove rahitisa na kosturu u usporedbi s kontrolnom skupinom djece.
  • 6. Rahitis zbog antikonvulzivnih lijekova • Antikonvulzivni lijekovi aktivacijom mikrosomnih enzima jetre ubrzavaju razgradnju kolesterola i 25-hidroksikalciferola na inaktivne razgradne produkte. • Zbog toga je konc. 25-hidroksikalciferola u serumu te djece snižena.
  • 7. Rahitis zbog antikonvulzivnih lijekova • Barbiturati i difenilhidantoinati imaju specifično inhibitorno djelovanje na resorpciju Ca iz crijeva. • Djeci na dugotrajnoj antikonvulzivnoj terapiji treba davati dodatnih 400 i.j. kalciferola/dan uz redovitih 400 i.j. u obliku prikladnog farmaceutskog pripravka.
  • 8. • Literatura: Duško Mardešić i suradnici. Pedijatrija Školska knjiga, Zagreb, 2003.