Endogenous Rickets.

Abstract

Active rickets has been observed in a number of patients whose intake of vitamins, calcium and phosphorus was fully adequate, according to our present knowledge of such requirements. Prolonged use of potent cod liver oil failed to induce healing. In each case, the blood serum calcium values were approximately normal, the phosphorus being markedly lowered. In this respect they differ from the findings with the rickets which may be associated with renal inadequacy, in which the calcium is low, the phosphorus normal or increased. Because of absence of any demonstrable exogenous etiology, these cases have been considered as of endogenous origin. While rachitic symptoms were sufficiently marked in each patient to demand medical attention, laboratory studies indicated the presence of other metabolic disturbances in each case. Among the diverse syndromes presented by these patients are included atypical diabetes mellitus, diabetes insipidus, and extrophy of the bladder with transplantation of the ureters to the rectum. Patients studied intensively showed disturbances of the acid-base balance, of varying type and degree. In one instance the rickets became inactive after sodium bicarbonate, 1 gm. 3 times daily, was added to the patient's previously ineffective antirachitic regime. The data indicate that probably an actual or relative base deficit was present in each case.