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  #1  
Old 09-16-2011
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Question Phosphate level in rickets

According to MTB-CK page 432, phosphate level is normal in vitamin D dependent rickets.
Since 1, 25 (OH) Vit D is decreased due to inadequate conversion from 25 (OH) Vit D, why would phospahte level be normal?

Someone please help? I'm confused
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Old 09-16-2011
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In vit D dependent rickets/vit D def :
Ca decreased; PO4 decreased; PTH high; Vit D OH2 decreased
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Old 09-16-2011
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I will just add what I got in medscape:

Type 1 vitamin D dependent ricket/vit.Dpseudodeficiency :

It is due to deficiency of 1alpha hydroxylase present in kidney responsible for conversion of 25OH vit D to diOH vitD, resulting in low calcium, phosporous and high PTH due to low level of 1,25diOH vitD. 25OH vitD is elevated to normal.


Type 2 vitamin D deficiency rickets /receptor defect rickets:

It is due to inherited abnormality in calcitriol receptor ,that results in end-organ resistance to vit.D. Therefore, there is elevated 1,25diOH vit D, low calcium due to receptor resistance and normal phosphate level.

In MTB-CK, I saw the table, I can't explain that on the basis of what I mentioned above.
anyone who knows please add on.
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In all types of Rickets, whether it's vitamin D dependent or not, the phosphate level is low.

That must be an error in MTB-CK, you can add it to this thread here MTB CK Errata (Errors and Corrections)

There are two threads that can help tremendously in mastering this issue:
this one
Phosphate Hormonal Control
and this one
Biochemical Abnormalities in Various Types of Rickets

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Old 09-16-2011
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Thanks guys for the prompt responses. I also agree phosphate should be low in rickets just like we all seem to agree with. I was just not sure why MTB said it should be normal.
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Old 09-16-2011
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Quote:
Originally Posted by StepTaker View Post
In all types of Rickets, whether it's vitamin D dependent or not, the phosphate level is low.

That must be an error in MTB-CK, you can add it to this thread here MTB CK Errata (Errors and Corrections)

There are two threads that can help tremendously in mastering this issue:
this one
Phosphate Hormonal Control
and this one
Biochemical Abnormalities in Various Types of Rickets

-
hey,
can u tell where does the defect lie, stepwise, in all of these 5 types of vid d deficiencies??

plus ur own table says po4 level could be low or normal..so there must be an explanation for a normal po4 in sum pts atleast??
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Old 09-16-2011
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Quote:
Originally Posted by aasiaafzal View Post
hey,
can u tell where does the defect lie, stepwise, in all of these 5 types of vid d deficiencies??

plus ur own table says po4 level could be low or normal..so there must be an explanation for a normal po4 in sum pts atleast??
It can be normal when the level of vitamin deficiency is not severe enough to cause low PO4 or when the patient is partially treated. In the USMLE Exam, they'll never give you normal Phosphorus level, to avoid confusion.

Here's a quick review of the causes of various types of rickets:
-Vitamin D Deficiency: low intake of vitamin D or decreased sun exposure
-Vitamin D Dependent: no conversion of 25(OH)D to 1,24(OH)D
-Vitamin D Resistant: receptor problem
-Hypophosphatemic rickets: problem is losing phosphate (not hypocalcemic)

-
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Old 09-18-2011
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lot of corrections to be made in mtb2 rickets table..
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Old 09-19-2011
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Quote:
Originally Posted by busterbee View Post
lot of corrections to be made in mtb2 rickets table..
don't do that table, skip it.
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Quote:
Originally Posted by aasiaafzal View Post
hey,
can u tell where does the defect lie, stepwise, in all of these 5 types of vid d deficiencies??

plus ur own table says po4 level could be low or normal..so there must be an explanation for a normal po4 in sum pts atleast??
aasia is this table correct..
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Old 09-20-2011
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Quote:
Originally Posted by busterbee View Post
aasia is this table correct..

seems correct..!! haven't studied it in detail though.....it would b better to check it out from emedicine or uptodate....
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Old 09-22-2011
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I like this thread. It is very unique for me. I like the content of this thread. Thanks for sharing it.
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