I. Vitamin D
1.The daily supply of vitamin D (VD) recommended by the Chinese Nutrition Society is 400 IU for children aged 0-6 years, 100 IU for those aged 7 years and above, and 400 IU for women during pregnancy and lactation.
2.The main source of VD required by human body is synthesized by skin contact with sunlight and obtained from food. When VD is deficient or insufficient, supplementation of VD preparation is needed to ensure normal growth and development of children or in the prevention and treatment of rickets.
3.The dose and method of VD use in this program is proposed from our specific situation to carry out the prevention and treatment of rickets in a large area, and has been proved to be safe and effective by practice in various places for many years.
4. The use of VD should take into account the specific situation of regions, seasons, children and pregnant women and drug sources, and vary from place to place, from time to time and from person to person. The dose can be less in the southern region or in summer and autumn, and more in the northern region or in winter and spring. When available, daily supplementation can be chosen. In rural areas or large area control, you can choose monthly or quarterly replenishment.
5. VD in this program refers to D2 (osteocalcin, from plants or synthesis) or D3 (cholecalciferol, from animals or synthesis). D2 and D3 anti-rickets potency, content determination method, use of dose, the same way of administration.
In view of the unstable nature of VD, it is easy to be oxidized and decomposed by light, heat, oxygen and chemical substances to reduce the content and potency. Therefore, when using VD, you should choose the dosage form with unit content, production date, expiration date and production unit, and the packaging is light-proof and airtight, and the content and potency are stable and convenient for children to take.
7.Some VD preparations or dosage forms (such as VD sugar nine, tablets, etc.) are trial products, and some dosage forms are easy to be oxidized and decomposed, and their content and potency and effective time are difficult to be determined, so it is not suitable to promote the application blindly, so as not to cause VD ineffective or poisoning.
8.Do not take a large amount of VD continuously for a long time. in the prevention and treatment of rickets, you should ask about the history of recent medication and use VD only when it is not routinely given within 1~2 months.
9.Cod liver oil contains a large amount of vitamin A (VA), when giving VD daily, you should choose a dosage form with a suitable ratio of VA to VD (3~4:1), or choose a simple VD preparation to prevent VA poisoning.
10. Oral calcium should be taken before or at the same time as using VD to treat rickets.
II. Calcium supplements
1, the Chinese Nutrition Society recommends that the daily dietary calcium supply is 400mg for 0-6 months, 600mg for 7 months-3 years, 800mg for 3 years and above, and 1000-1200mg for pregnant and lactating women. the above supply refers to elemental calcium, including the poor absorption and utilization of calcium.
2, the body needs calcium can be obtained from the diet, when the calcium supply in the food is not enough or the body calcium deficiency, only then need to use calcium supplements to supplement.
3, commercially available calcium content, according to the pharmacopoeia regulations to calcium salt unit weight or unit volume to label, more than the amount of elemental calcium is not marked.
4. It is difficult to determine how much elemental calcium or combined calcium is needed when using calcium supplements. The appropriate dose can only be selected based on age, feeding, diet and medical history of children and pregnant women.
5. The dose of calcium supplementation in this program is based on experience and is given in terms of the combined calcium content. The purpose is to supplement the calcium deficit in the diet. The amount of elemental calcium contained in various commercially available calcium preparations varies from 10% to 40%. That is, to give 1g of calcium can get elemental calcium is about 100 ~ 400mg.
6.There are many kinds of commercially available calcium supplements, it is advisable to choose a preparation or form that is rich in elemental calcium, easy to dissolve and absorb, and easy to take.
7.The purpose of using calcium supplements is to supplement the insufficient intake from food or the missing part in the body. The appropriate amount of calcium should be given to those with a history of calcium deficiency or during treatment. The amount of calcium supplementation proposed in the program is about 1/2 of the supply, and the rest should be taken from food.
8. Calcium should be taken orally when used. If it cannot be taken orally, it can be injected intravenously, but the speed must be slow and should be diluted.
9, in calcium should be given at the same time should be supplemented with an appropriate amount of VD, in order to increase the absorption and utilization of calcium.
10. Do not use large amounts of calcium for a long time to prevent hypercalcemia and affect the absorption of other elements.
Prevention and treatment of vitamin D poisoning
Misuse, abuse, overdose, allergy, medical source or long-term use of various VD cumulative effects can lead to VD poisoning.
Mild symptoms
The early stage of poisoning may show hypothermia, irritability, anorexia, nausea, vomiting, diarrhea, constipation, thirst, weakness, etc.
Severe illness
Late stage may show high fever, polyuria, oliguria, dehydration, drowsiness. Coma, convulsions and other symptoms. Severe cases can be fatal due to hypercalcemia and renal failure.
Laboratory tests may show increased blood calcium, urine calcium, urine protein or blood urea nitrogen. x-ray shows excessive calcification in the temporary calcified zone of long bones, increased density, thickened bone cortex, and ectopic calcified foci in other tissues and organs.
Treatment
Immediate discontinuation of vitamin D, management of hypercalcemia, restriction of calcium salt intake, administration of diuretics to accelerate calcium excretion, and application of prednisone to inhibit intestinal absorption of calcium are generally effective except for severe cases with irreversible renal damage.
Prevention
We should make good use of natural conditions and promote more sunshine. The rational use of vitamin D is the key to prevent VD) poisoning, attention should be paid to mastering VD dose and application time, and should be closely observed.