Lactose intolerance

Is the inability to digest lactose, a sugar found in milk and other dairy products and is caused by a deficiency of the enzyme lactase.

Alternative NamesMilk intolerance, lactase deficiency, disaccharidase deficiency, dairy product intolerance\

 Causes and Risk FactorsLactose intolerance occurs when the intestine does not produce enough lactase enzyme. Babies' bodies make this enzyme so they can digest milk, including breast milk. Before humans became farmers and processed dairy products, most people do not continue to drink milk in your life, so that did not produce lactase after early childhood.
People from cultures in which the consumption of milk and dairy products in adults occurred earliest are less likely to suffer from lactose intolerance than those belonging to villages where the consumption of dairy farming began more recently. As a result, lactose intolerance is more common in Asian, African American, Native American, and Mediterranean populations of northern and western Europe.
Lactose intolerance can begin at different times in life. In Caucasians, it usually starts to affect children older than 5 years, while the black people, the condition often occurs up to two years old.
When people with lactose intolerance eat or drink dairy products, may have symptoms such as bloating, excessive intestinal gas, nausea, diarrhea and abdominal cramps.
Lactose intolerance is not dangerous and is very common in adults. Approximately 30 million American adults have some degree of lactose intolerance by age 20 years.
Lactose intolerance is sometimes seen in premature babies and babies born at full term generally do not show signs of this condition until they are at least 3 years of age.
The fact of not having milk in the diet can cause a shortage of calcium, vitamin D, riboflavin and protein, so you need a milk substitute. Soy preparations are adequate substitutes for bottle babies under 2 years and for children toddlers, soy milk and rice are good alternatives. Older children may also consume cow's milk treated with lactase. Goat's milk is low in lactose, but should only be used with children if properly fortified with vitamins and essential amino acids.
Most people with low lactase can tolerate 2 to 4 ounces of milk at one time (up to half a cup), but larger portions (8 ounces) can cause problems for those with some degree of intolerance to milk.
Lactase deficiency may also occur as a result of intestinal diseases such as celiac sprue and gastroenteritis, or also manifest after intestinal surgery. This may be a temporary lactase deficiency due to bacterial or viral infections, especially in children, when injured cells lining the intestine. 
Symptoms

•     Abdominal cramps
•     Distension
•     Flatulence
•     Weight Loss
•     Malnutrition
•     Slow growth
•     Bloating
•     Diarrhea
•     Floating stools
•     Foul-smelling stools

Symptoms often occur after the ingestion of dairy products and often relieved by the suspension of the same. Large doses of milk products may cause worse symptoms.

Signs and tests

•     Test for stool-reducing substances
•     Proof of lactose tolerance
•     Breath test for lactose-hydrogen
•     Small bowel biopsy

Treatment
Symptoms usually are relieved with the suspension of dairy products in the diet, in which case it should be incorporated into food sources of calcium.
Usually can tolerate fermented milk products like yogurt. Sometimes, patients tolerate goat's milk, but it is recommended taken with meals, not alone. Also, consider that the butter milk and cheeses have less lactose than milk itself.
It may help to consumption of milk and lactose-free dairy products. Also, you can add lactase enzymes to regular milk or take them in capsule or chewable tablet form.
You should read food labels, because the lactose found in some non-milk products, including some beers. 
Expectations (prognosis)Usually, symptoms disappear once you stop consuming dairy products in the diet. 
ComplicationsPossible complications include weight loss and malnutrition. 
Calling your health careSeek medical attention if a child or adult has symptoms of lactose intolerance in order to seek food substitutes. Even when symptoms worsen or do not improve with treatment or if new symptoms. 
PreventionThere is no known way to prevent the development of lactose intolerance. However, if you have this condition, you can avoid or limit consumption of dairy products to reduce or eliminate symptoms.



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Side effects of medications used to treat seizures

Seizures
It is a sudden change in behavior due to an excessive electrical activity in the brain. 
ConsiderationsDepending on the part of the brain affected, a wide variety of possible symptoms of a stroke or seizure. Many types of seizures cause loss of consciousness with twitching or shaking of the body. However, some seizures consist of staring spells that can easily go unnoticed. Occasionally, they can cause temporary abnormal sensations or visual disturbances.
Usually, attacks or seizures can be classified into "simple" (no change in level of consciousness) or "complex" (change in level of consciousness). Can also be classified as generalized (whole body affected) or focal (affecting only one part or side of the body).
Epilepsy is a chronic disorder with recurrent seizures. Some types of epilepsy are hereditary.
See also:

•     Epilepsy
•     Crisis petit mal
•     Tonic-clonic (grand mal seizure)
•     Partial (focal)
•     Temporal lobe seizures
•     Febrile seizure (convulsions in children with high fever)

Causes
Any condition that results in abnormal electrical excitation of the brain can trigger a seizure, including:

•     Epilepsy
•     Injury or trauma to the head
•     Infection (brain abscesses, meningitis)
•     Brain tumor
•     Stroke

Also, any medical condition that irritates brain cells. Medical conditions that commonly cause seizures include:

•     Hypoglycemia (low blood sugar)
•     Drug use (especially cocaine or stimulants)
•     high fever (fever convulsions in children)
•     Alcohol withdrawal

Home Care
People with epilepsy should always wear a medical alert tag.
Most seizures are self-limiting and stop by themselves after various periods of time. However, the victim may get hurt, suck some food, liquid or vomiting, or not getting enough oxygen. During a seizure is important to protect the victim from injury. He turns the head of the victim if there is vómito.Ver first aid in case of attack.
After a convulsion, most people go into a deep sleep. Do not stop to sleep. It is possible that after awakening disoriented for some time.
Stay with the person until recovery or until professional medical help arrives. Meanwhile, monitor their pulse, breathing rate, blood pressure.

•     DO NOT restrain the victim
•     DO NOT place anything between the teeth during a seizure (including your fingers)
•     DO NOT move the victim unless it is in danger or near something hazardous
•     DO NOT try to stop the seizure of the victim, the person can not control the seizure and did not realize what is happening.
•     DO NOT give anything by mouth to the victim until the convulsions have stopped and the person is fully conscious and alert

Some patients with epilepsy, they may implant a vagus nerve stimulator in the chest, which may stop the seizures will activate this device. Other patients may be prescribed medication to administer rectally during a seizure. Do not give anything by mouth, even medications. 
Call your doctor ifInform your doctor about all seizures (even if mild). People affected by epilepsy or recurrent seizures should visit the doctor to adjust medications or other instructions.
If this is the first time that a seizure or if there is a new type of seizure, bring the patient to the doctor immediately, as these symptoms may indicate a terminal condition such as stroke or meningitis.
PreventionThere is no specific way to prevent attacks. If necessary, use of a helmet to prevent injury, which will reduce the chances of a brain injury and subsequent attacks. Avoid recreational drugs. People with epilepsy should take medication as instructed by your doctor and avoid taking excessive amounts of alcohol.What to expect at the doctor's
The doctor does a physical exam and ask questions that help you learn the cause of the attack. Here are some of the questions:

•     Did it happen or start on one side of the body?
•     There movement of muscles and if so, what was the pattern?
•     Are there risk factors (such as recent head injury)?
•     Are remained conscious during the attack?
•     How long did the attack?
•     What is the frequency of the seizures?
•     Is there any warning (aura) of the attack?
•     Were there any other symptoms (visual changes, abnormal smells)?

You can perform the following tests:

•     Head CT or MRI of the head
•     EEG
•     Lumbar puncture
•     Blood tests

Often medications are prescribed which must be taken with great precision following your doctor's instructions. Family members should observe and keep a diary of all attacks in order to get proper treatment.
People with uncontrolled seizures should not drive. Each state has a different law that determines which patients are allowed to drive. People who suffer from seizures should not swim or ride a bike without company. 
ReferencesGoetz, CG. Textbook of Clinical Neurology. 2nd ed. St. Louis, MO: WB Saunders, 2003: 1158-1160.
Marx J. Rosen's Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby, 2002:145-149, 1445.
Hirtz D, Ashwal S, Berg A, et al. Practice parameter: Evaluating a first seizure in children nonfebrile: Report of the Quality Standards Subcommittee of the American Academy of Neurology, the Child Neurology Society, and the American Epilepsy Society. Neurology. 2000, 55, 616-623.

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Acidosis

It is a condition characterized by excess acid in body fluids. 
Causes and Risk FactorsThe acid-base balance of the body (pH) is regulated by the kidneys and lungs. Acidosis is caused by a buildup of acid or a significant loss of bicarbonate. The main types of acidosis are respiratory acidosis and metabolic acidosis.
The human body is programmed to correct for either respiratory or metabolic acidosis to maintain normal pH. For example, if acidosis is caused by excess carbon dioxide is an acid that the body will correct the pH by retaining bicarbonate, which is a basis.
Respiratory acidosis develops when there is excessive amounts of carbon dioxide in the body, due mainly to a decrease in breathing. Other names for this include hypercapnic acidosis and carbon dioxide acidosis.
There are several types of metabolic acidosis: lactic acidosis, also called diabetic ketoacidosis and DKA develops when ketone bodies accumulate during uncontrolled diabetes mellitus.
Hyperchloremic acidosis results from excessive loss of sodium bicarbonate from the body, as for example with severe diarrhea.
Lactic acidosis is a buildup of lactic acid, which can be caused by many conditions, including prolonged lack of oxygen (for example, shock, heart failure or severe anemia), prolonged exercise, seizures, hypoglycemia (low sugar blood), alcohol, liver failure, malignancy, or certain medications like salicylates.
Other causes of metabolic acidosis include severe dehydration resulting in decreased muscle perfusion (decreased blood flow), kidney disease (see distal renal tubular acidosis and proximal renal tubular acidosis) and other metabolic diseases.

SymptomsSee the specific types of acidosis.Signs and tests
An analysis of blood gases or blood chemistry (such as basic blood chemistry analysis), will confirm acidosis in most cases. Other tests may be required to determine the cause of acidosis. 
TreatmentTreatment depends on the cause. See specific types of acidosis.Expectations (prognosis)
Acidosis can be dangerous if not treated. Many of the causes respond well to treatment. 
ComplicationsSee the specific types of acidosis.Calling your health care
Although there are several types of acidosis, all will cause symptoms that require medical treatment. See the specific types of acidosis.

PreventionPrevention or treatment of the underlying causes may prevent some cases of acidosis.


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Acute renal failure

It is the sudden loss of the ability of the kidneys to remove waste and concentrate urine without losing electrolytes.

Alternative NamesKidney failure, acute kidney failure, kidney failure, kidney failure

Causes and Risk FactorsThere are many possible causes of kidney damage, such as:

•     Decreased blood flow can occur with extremely low blood pressure caused by trauma, surgery, serious illness, septic shock, hemorrhage, burns or dehydration.
•     Acute tubular necrosis (ATN)
•     Infections that directly injury the kidney such as acute pyelonephritis or septicemia.
•     Urinary tract obstruction (obstructive uropathy).
•     Autoimmune kidney disease such as interstitial nephritis or acute nephritic syndrome.
•     Disorders that cause clotting within the thin blood vessels of the kidney, as
•         idiopathic thrombocytopenic purpura (ITP)
•         transfusion reaction
•         malignant hypertension
•         Scleroderma
•         Hemolytic uremic syndrome
•         disorders resulting from childbirth as bleeding, placental abruption or placenta previa

Symptoms

•     Decreased urine output (oliguria)
•     No urine output (anuria)
•     Excessive nighttime urination
•     Swollen ankles, feet and legs
•     Generalized swelling from fluid retention
•     Decreased sensation, especially in the hands or feet
•     Loss of appetite
•     Metallic taste in mouth
•     Persistent hiccups
•     Changes in mental status or mood

1.         agitation
2.         sleepiness
3.         lethargy
4.         delirium or confusion
5.         coma
6.         fluctuating mood
7.         difficulty paying attention
8.         hallucinations

•     Slow, sluggish movement
•     Seizures
•     Hand tremor
•     Nausea or vomiting that can last for days
•     Tendency to bruising
•     Prolonged bleeding
•     Nosebleed
•     Bloody
•     Flank pain
•     Fatigue
•     Bad breath
•     High blood pressure

Signs and tests
The exams and tests can help diagnose acute kidney failure and rule out other problems that can affect kidney function.
Many patients have generalized swelling caused by fluid retention. The doctor uses a stethoscope to listen to your heart and lungs. During this procedure, you can hear a heart murmur, crackles in the lungs, inflammation of the lining of the heart (pericarditis), or other sounds related to the presence of extra fluid.
The results of laboratory tests may change suddenly (within a few days to 2 weeks):

•     Urine tests (urine analysis) may be abnormal
•     The levels of serum creatinine, urea, ability to creatinine clearance and serum potassium may increase
•     Arterial blood gas and blood chemistry analysis may show metabolic acidosis
•     The tests are preferred Kidney or abdominal ultrasound, but abdominal radiography, abdominal computed tomography scan or abdominal MRI can tell if there is a blockage in the urinary tract.
•     Blood tests may help reveal the underlying causes of kidney failure.

Treatment
Once you have found the cause, the goal of treatment is to restore kidney function and prevent fluid and waste accumulate in the body while the kidneys heal. Generally, patients have to stay overnight in the hospital for treatment.
The amount of liquid that you take (such as soup) or drink will be limited to the amount of urine you can produce. You will be told what can and can not eat in order to reduce the accumulation of toxins normally handled by the kidneys. This diet can be rich in carbohydrates and low in protein, salt and potassium.
You may need antibiotics to treat or prevent infection and can be tested with diuretics to help the kidneys lose fluid.
It will be very important to avoid dangerous hyperkalemia (increased potassium levels in the blood) using calcium IV (intravenous), glucose / insulin or potassium exchange resin (Kayexalate).
Dialysis may be necessary and may make the person feel better. However, it is not always necessary but can save your life if serum potassium is dangerously high. Dialysis is also used if the person's mental status changes, your potassium level starts to rise, you stop urinating, develop pericarditis, fluid overload or it can not eliminate nitrogen waste from the body.Support Groups
The stress of illness can often be eased by joining a support group where members share common experiences and problems. View support group for kidney disease. The local hospital or dialysis center can probably specializes in providing information about local support groups.Expectations (prognosis)
Although acute renal failure is life threatening and may require intensive treatment, the kidneys usually start working again within a period of several weeks to months after the underlying cause treated.
In cases where this does not happen, has chronic renal failure or end-stage renal disease. Death can occur, but is most common when kidney failure is caused by surgery, trauma or severe infection in someone with heart disease, lung disease or recent stroke. Old age, infection, blood loss from the gastrointestinal tract and the progression of kidney failure also increase the risk of death. 
Complications

•     Bleeding in the intestines
•     Chronic renal failure (long)
•     End-stage renal disease
•     Damage to the heart or nervous system
•     Hypertension (high blood pressure)

Calling your health care
Call your health care provider if absent or decreased urine output, or if you have other symptoms of acute renal failure.


PreventionThe treatment of disorders such as high blood pressure can help prevent acute renal failure. However, unfortunately, the prevention is not always possible.


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Malabsorption can make the osteomalacia disease

Is difficulty digesting or absorbing nutrients from food.
Causes and Risk Factors

Malabsorption can result from a wide range of diseases. Typically, malabsorption can be the inability to absorb sugars, fats, proteins or vitamins, or they may also be a general malabsorption of food. Malabsorption may be accompanied by diarrhea, bloating or cramping, failure to thrive, frequent bulky stools, muscle atrophy and distension of the stomach.

Malabsorption can affect growth and development and can lead to specific diseases. Some causes of malabsorption include:

•      Cystic fibrosis (the number one cause in the United States)
•      chronic pancreatitis
•      Lactose intolerance
•      celiac disease
•      Whipple's Disease
•      Shwachman-Diamond syndrome (a genetic disease that affects the pancreas and bone marrow)
•      Protein intolerance of cow's milk
•      Intolerance to milk protein soy
•      biliary atresia
•      abetalipoproteinemia

     Malabsorption of vitamin B-12 due to:

•          Diphyllobothrium latum infestation
•          Juvenile pernicious anemia
•      vermin
•          Giardia lamblia
•          Strongyloides stercoralis
•          Necator americanus (hookworm)

symptoms

•      Avoiding specific foods
•      chronic diarrhea
•      Bloating and gas
•      Growth retardation

Signs and tests

See the individual conditions.
treatment

See the individual conditions.
Expectations (prognosis)

See the individual conditions.
complications

Malabsorption may lead to prolonged malnutrition and vitamin deficiencies.
Calling your health care

Call your health care provider if you notice symptoms of malabsorption.
prevention

See the individual conditions.


source: clinicadam.com

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Rickets and the efect

Rickets
It is a disorder primarily caused by lack of vitamin D, calcium or phosphate, which leads to softening and weakening of bones.Alternative Names
Vitamin D deficiency, osteomalacia in children, renal ricketsCauses and Risk Factors
Vitamin D helps the body properly control calcium and phosphorus levels in the body. When the body lacks vitamin A, is unable to adequately control the levels of these minerals. If the blood levels of these minerals become too low, the body may produce other body hormones to stimulate release of calcium and phosphate from the bones, which leads to weak and soft bones present.
Vitamin D can be absorbed from food or produced by the skin when it is exposed to sunlight. Lack of vitamin D production by the skin can occur if the person is confined indoors, work indoors during daylight hours or live in climates with little exposure to sunlight.
Because vitamin D is a fat soluble vitamin, malabsorption disorders that reduce digestion or absorption of fats will decrease the ability of vitamin D to be absorbed into the body.
Deficiency of vitamin D in the diet can occasionally be seen in vegetarians, who do not drink milk products, or those who have lactose intolerance (those who have trouble digesting dairy products). Babies fed exclusively on breast milk may also develop vitamin D deficiency, because the milk does not supply the proper amount of the vitamin. This can be a particular problem for darker-skinned children in winter months when sunlight levels lower.
Inadequate intake of calcium and phosphorus in the diet can also lead to rickets. Rickets caused by a dietary lack of these minerals is rare in developed countries because calcium and phosphorus found in milk and green leafy vegetables.
Your genes may increase your risk of rickets. Hereditary rickets is a disease that is transmitted through families and occurs when the kidneys are unable to retain phosphorus. Rickets may also be caused by kidney disorders involving renal tubular acidosis.
Occasionally, rickets may also occur in children who have liver problems or can not convert vitamin D to its active form.
Rickets is rare in the United States. Most likely to occur during periods of rapid growth when the body demands high levels of calcium and phosphorus. It is usually seen in children 6 to 24 months of age and is uncommon in newborns.Symptoms

    Bone pain or tenderness
        arms
        legs
        column
        pelvis
    Skeletal deformities
        bowlegged
        forward projection of the breastbone (pigeon chest)
        Bumps in the rib cage (rachitic rosary)
        Skull asymmetrical or odd-shaped
        spinal deformities (spine curves abnormally, including scoliosis or kyphosis)
        Pelvic deformities
    Increased tendency toward bone fractures
    Dental deformities
        Delayed formation of teeth
        defects in the structure of teeth, holes in the enamel
        increased incidence of tooth decay (dental caries)
        progressive weakness
        decreased muscle tone (loss of muscle strength)
    Muscle cramps
    Poor growth
    Short stature adults within 1.52 m (5 ft) high
Signs and tests
A physical exam reveals tenderness or pain in the bones, rather than in the joints or muscles.
The following tests may help diagnose rickets:

    Blood tests (serum calcium) may show low levels of calcium.
        tetany (prolonged muscle spasm) which may occur if serum levels of calcium are low
        Chvostek's sign may be positive (a spasm of facial muscles when facial nerve is tapped) indicating low serum calcium levels
    Serum phosphorus may be low.
    Serum alkaline phosphatase may be high.
    Arterial blood gases may reveal metabolic acidosis.
    X-rays of the bones may show loss of calcium from bones or changes in form or structure of these.
    A bone biopsy is rarely performed but will confirm rickets.
Other tests and procedures include the following:

    PTH
    Urine calcium
    Calcium (ionized)
    Isoenzyme of ALP (alkaline phosphatase)
Treatment
The goal of treatment is to relieve symptoms and correct the cause of this condition. You must treat the underlying cause to prevent recurrence.
With the replacement of deficient calcium, phosphorus or vitamin D will eliminate most symptoms of rickets. Dietary sources of vitamin D include fish, liver and processed milk. It is recommended that exposure to moderate amounts of sunlight. Treating rickets caused by metabolic abnormalities may require a special prescription for vitamin D.
Good posture and the use of braces to help reduce or prevent deformities. In addition, you may need surgical correction of some skeletal deformities.Expectations (prognosis)
The disorder can be corrected with replacement of minerals and vitamin D deficient. Laboratory values ​​and x-rays usually improve after almost a week of treatment, although some cases may be resistant and require large doses of minerals and vitamin D.
If rickets is not corrected while children are still growing, skeletal deformities and short stature may be permanent. Conversely, if it is corrected while the child is young, skeletal deformities often diminish or disappear over time.Complications

    Chronic skeletal pain
    Skeletal deformities
    Skeletal fractures, may occur without cause
Calling your health care
Call your pediatrician if you notice symptoms of rickets.Prevention
Rickets may be avoided by having your child maintain an adequate intake of calcium, phosphorus and vitamin D. This may require dietary supplementation in people with gastrointestinal disorders or other conditions, which you should consult your pediatrician.
The renal causes of malabsorption of vitamin D should be treated promptly and levels of calcium and phosphorus should be monitored regularly in people with kidney disease.
Genetic counseling can help people with a family history of inherited disorders that can cause rickets.


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Calcium in diet

Calcium in diet
Calcium is the most abundant mineral found in the human body, with teeth and bones contain the most calcium (about 99%). Body tissue, neurons, blood and other body fluids contain the remaining calcium.Alternative Names

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vitamin D can make the intestines absorb too much calcium

Too much vitamin D can make the intestines absorb too much calcium, which can cause high levels of this mineral in the blood. High levels of calcium in the blood can lead, in turn, presented to the mineral deposits in soft tissues like the heart and lungs, which may reduce their ability to function.

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Osteomalacia: symptomes, sign and treatment

Osteomalacia
Is the softening of bones caused by a deficiency of vitamin D or problems with the metabolism (breakdown and use) of this vitamin. These softer bones have a normal amount of collagen that gives structure to bones, but lack of calcium.Causes and Risk Factors
Numerous causes of osteomalacia. In children, the condition is called rickets and causes often deficient in vitamin D.
Conditions that can lead to osteomalacia include:

•     Not enough vitamin D in the diet
•     Enough exposure to sunlight, which produces vitamin D in the body
•     Malabsorption of vitamin D from the gut

Other conditions that may cause osteomalacia include:

•     Hereditary or acquired disorders of the metabolism of vitamin D
•     Kidney failure and acidosis
•     Renal phosphate consumption associated with diets deficient in
•     Cancer
•     Side effects of medications used to treat seizures
•     Liver disease

The use of strong sunscreen, limited exposure of the body to sunlight, short days of sunlight, and smog are factors that reduce formation of vitamin D in the body.
Risk factors for osteomalacia are related to the causes. Among the elderly, there is an increased risk in those who tend to remain indoors and those who avoid milk because of lactose intolerance. 
Symptoms

•     Diffuse bone pain (not located at an exact point), especially in the hips
•     Muscle weakness
•     Bone fractures that occur with minimal trauma

Symptoms associated with low levels of calcium include:

•     Numbness around the mouth
•     Numbness of extremities
•     Spasms of the hands and feet
•     Abnormal heart rhythm

Signs and tests

•     A bone biopsy shows osteomalacia
•     The level of vitamin D levels may be low
•     Serum calcium levels vary with the cause of the disorder
•     Serum phosphate levels vary with the cause of the disorder
•     Bone x-rays may show features of osteomalacia, such as bowed legs or "pseudofractures"
•     A scan of the bone mineral density (DEXA) may show reduced bone density, a sign of weaker bones

You can perform other tests to determine if a kidney problem or any other underlying disorder. These may include:

•     PTH
•     Calcium (ionized)
•     Isoenzyme of alkaline phosphatase (ALP)

Treatment
May be given oral supplements of vitamin D, calcium and phosphorus, depending on the underlying cause of the disorder. They may require large doses of vitamin D and calcium in people with intestinal malabsorption.
You may also require controlling the levels of phosphorus and calcium in the blood in people with certain underlying conditions.Expectations (prognosis)
Improving the condition of the bones, seen through bone radiographs, can be seen in a few weeks in some people with vitamin deficiency disorders. Complete healing with this treatment is given within six months.Complications
The reappearance of symptoms is a possible complication.Calling your health care
The person should seek medical attention if symptoms of osteomalacia or think you may be at risk.Prevention
Adults can prevent osteomalacia resulting from vitamin D deficiency with an adequate intake of dairy products fortified with this vitamin, as with adequate exposure to sunlight.



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Osteomalacia is a bone disease

General
Osteomalacia is a bone disease in which bone density decreases due to vitamin D deficiency. The bone is about one-third of developed materials that are produced by special cells called osteoblasts. Two-thirds of the bone mass are made of minerals, especially calcium,

which are incorporated into this matrix and thereby give the bone until the necessary hardness. In osteomalacia can be absorbed into the body due to vitamin D deficiency, too little calcium in the gut. The bone is the resulting reduction of hard, mineralized bone, which is then replaced by non-mineralized matrix, much softer. The result is that the bone bends in the most polluted regions. Basically, the cause must be sought at all stages of calcium metabolism. Vitamin D, which is responsible for the uptake of calcium absorbed from food in the gut may be decreased due to a deficiency or malnutrition. Vitamin D can also by our bodies from its precursors, which we absorb from food, are formed. This requires that the precursors are converted in our body three times: once with the help of sunlight in the skin, a second time in the liver and a third time in the kidney. With lack of sunlight, as this can occur for example in nursing home residents, or kidney disease can therefore lead to a vitamin D deficiency. Some drugs, such as stomach acid blockers or some epilepsy medications can lead to different ways to a vitamin D deficiency and thus to a reduced calcium absorption in the intestine. Back to top Symptoms
Osteomalacia in the elderly is only symptomatic and develops insidiously. The extent of symptoms depends on the bone mass at the beginning of the disease and the cause of the disorder that leads to vitamin D deficiency. The initial symptoms are muscle weakness, joint pain and diffuse pain throughout the skeletal system. These symptoms are nonspecific and resemble normal age-related complaints. For this reason, the disease is often diagnosed only late, namely when she has osteoporosis-like symptoms. The reduced bone density facilitates the formation of vertebral fractures. After multiple spinal fractures can be in the top half of the back form a hump, which is also known as dowager's hump. The noticeable decrease in body size is also caused by vertebral fractures. Back to top Diagnosis
The physical examination contributes little to the disease at diagnosis. Note the body extending over the whole pain in the skeletal system. Especially painful are the higher stress regions of the musculoskeletal system. Through the bone remodeling produces substances that can be detected in the blood, especially the alkaline phosphatase. Crucial for the diagnosis of osteomalacia that is why the blood test, because at the very similar osteoporosis manifesting this degradation product can not be detected in unusually high amounts. With an X-ray image, the loss of bone mass are shown. Suspicious for osteomalacia are so-called conversion Looser zones, formed by the replacement of a hard, mineralized bone by soft bone. This conversion Looser zones are found mainly on exposed bone points and often lead to fatigue fractures. When x-ray of the spine the same changes are visible as in osteoporosis. Vertebral fractures by vertebral bodies are wedge-shaped or deformed fish, or it can be seen cranked deck or belly plates. Ambiguities must be removed during a bone sample, which after appropriate preparation, can be examined under a microscope. This can be distinguished from similar bone disease osteomalacia. Back to top Therapy
The treatment of osteomalacia is according to the underlying disorder in a supply of vitamin D. If a vitamin D deficiency due to a deficiency or malnutrition before, as can occur for example in strict vegetarians or a fat-free diet is taken vitamin D in the form of drops or capsules. If the fed vitamin D is indeed supplied in sufficient quantities, but can not be absorbed, the substance must be injected directly into the bloodstream. As described above, can disable various medications, vitamin D and thus lead to a vitamin deficiency. In this case, often very high doses of the vitamin is needed to compensate for the deficiency. If the cause of osteomalacia is corrected, may very pronounced and debilitating deformations of the musculoskeletal system may be removed by surgery.


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