{"id":1524,"date":"2015-09-20T17:00:00","date_gmt":"2015-09-20T10:00:00","guid":{"rendered":"https:\/\/yhoccongdong.org\/du-an-khoa-nhi\/2018\/08\/19\/ngan-ngua-va-dieu-tri-su-thieu-hut-vitamin-d-cho-tre-so-sinh-va-tre-nho-o-ec-va-newzealand-y-kien-thong-nhat\/"},"modified":"2024-03-04T13:46:57","modified_gmt":"2024-03-04T06:46:57","slug":"ngan-ngua-va-dieu-tri-su-thieu-hut-vitamin-d-cho-tre-so-sinh-va-tre-nho-o-ec-va-newzealand-y-kien-thong-nhat","status":"publish","type":"post","link":"https:\/\/yhoccongdong.com\/nhi-khoa\/ngan-ngua-va-dieu-tri-su-thieu-hut-vitamin-d-cho-tre-so-sinh-va-tre-nho-o-ec-va-newzealand-y-kien-thong-nhat\/","title":{"rendered":"Ng\u0103n ng\u1eeba v\u00e0 \u0111i\u1ec1u tr\u1ecb s\u1ef1 thi\u1ebfu h\u1ee5t vitamin D cho tr\u1ebb s\u01a1 sinh v\u00e0 tr\u1ebb nh\u1ecf \u1edf \u00dac v\u00e0 Newzealand: \u00fd ki\u1ebfn th\u1ed1ng nh\u1ea5t"},"content":{"rendered":"<h2 id=\"tom-tat\" style=\"text-align: justify\">\u200b\u200b <span style=\"line-height: 1.2em\"> T\u00f3m t\u1eaft <\/span><\/h2>\n<ul style=\"text-align: justify\">\n<li>Thi\u1ebfu h\u1ee5t vitamin D l\u1ea1i xu\u1ea5t hi\u1ec7n nh\u01b0 m\u1ed9t v\u1ea5n \u0111\u1ec1 s\u1ee9c kh\u1ecfe nhi khoa quan tr\u1ecdng v\u1edbi c\u00e1c bi\u1ebfn ch\u1ee9ng bao g\u1ed3m h\u1ea1 canxi m\u00e1u, c\u00f2i x\u01b0\u01a1ng, \u0111au nh\u1ee9c ch\u00e2n tay v\u00e0 g\u00e3y x\u01b0\u01a1ng.<\/li>\n<li>Nguy c\u01a1 ch\u00ednh g\u00e2y thi\u1ebfu Vitamin D \u1edf tr\u1ebb s\u01a1 sinh l\u00e0 s\u1ef1 thi\u1ebfu h\u1ee5t vitamin D c\u1ee7a m\u1eb9 trong khi mang thai. V\u1edbi tr\u1ebb nh\u1ecf v\u00e0 tr\u1ebb l\u1edbn, nh\u1eefng y\u1ebfu t\u1ed1 nguy c\u01a1 bao g\u1ed3m: da t\u1ed1i m\u00e0u, t\u1eadp qu\u00e1n v\u0103n h\u00f3a, b\u00fa s\u1eefa m\u1eb9 k\u00e9o d\u00e0i, h\u1ea1n ch\u1ebf ti\u1ebfp x\u00fac \u00e1nh s\u00e1ng m\u1eb7t tr\u1eddi v\u00e0 \u0111i\u1ec1u ki\u1ec7n y t\u1ebf nh\u1ea5t \u0111\u1ecbnh.<\/li>\n<li>\u0110\u1ec3 ng\u0103n ng\u1eeba thi\u1ebfu h\u1ee5t vitamin D \u1edf tr\u1ebb s\u01a1 sinh, ph\u1ee5 n\u1eef mang thai, \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1eefng ng\u01b0\u1eddi c\u00f3 m\u00e0u da t\u1ed1i hay th\u01b0\u1eddng che k\u00edn m\u1eb7t. N\u00ean \u0111\u01b0\u1ee3c ki\u1ec3m tra v\u00e0 \u0111i\u1ec1u tr\u1ecb thi\u1ebfu h\u1ee5t vitamin D. V\u00e0 tr\u1ebb s\u01a1 sinh b\u00fa s\u1eefa c\u1ee7a nh\u1eefng ng\u01b0\u1eddi m\u1eb9 n\u00e0y n\u00ean \u0111\u01b0\u1ee3c b\u1ed5 sung vitamin D trong 12 th\u00e1ng \u0111\u1ea7u \u0111\u1eddi.<\/li>\n<li>Ti\u1ebfp x\u00fac v\u1edbi \u00e1nh s\u00e1ng m\u1eb7t tr\u1eddi th\u01b0\u1eddng xuy\u00ean c\u00f3 th\u1ec3 ph\u00f2ng ng\u1eeba thi\u1ebfu h\u1ee5t vitamin D. Nh\u01b0ng kho\u1ea3ng th\u1eddi gian ti\u1ebfp x\u00fac an to\u00e0n cho tr\u1ebb v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c l\u00e0m r\u00f5.<\/li>\n<li>\u0110\u1ec3 ng\u0103n ng\u1eeba thi\u1ebfu h\u1ee5t vitamin D, tr\u1ebb em c\u00f3 nguy c\u01a1 n\u00ean b\u1ed5 sung 400 IU vitamin D h\u00e0ng ng\u00e0y. N\u1ebfu \u0111i\u1ec1u n\u00e0y kh\u00f3 th\u1ef1c hi\u1ec7n, c\u00f3 th\u1ec3 xem x\u00e9t b\u1ed5 sung m\u1ed9t li\u1ec1u 150.000 IU h\u00e0ng n\u0103m.<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb thi\u1ebfu h\u1ee5t vitamin D bao g\u1ed3m cung c\u1ea5p ergocalciferol (vitamin D2) v\u00e0 cholecalciferol ( vitamin D3) trong kho\u1ea3ng 3 th\u00e1ng. (1000 IU\/ng\u00e0y n\u1ebfu d\u01b0\u1edbi 1 th\u00e1ng tu\u1ed5i; 3000 IU\/ng\u00e0y n\u1ebfu t\u1eeb 1-12 th\u00e1ng tu\u1ed5i; 5000 IU\/ng\u00e0y n\u1ebfu tr\u00ean 12 th\u00e1ng tu\u1ed5i.)<\/li>\n<li>Li\u1ec7u ph\u00e1p b\u1ed5 sung 1 li\u1ec1u cao (300 000- 500 000 IU) n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t \u0111\u1ed1i v\u1edbi tr\u1ebb em tr\u00ean 12 th\u00e1ng tu\u1ed5i. Khi nghi ng\u1edd c\u00f3 v\u1ea5n \u0111\u1ec1 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb hay k\u00e9m h\u1ea5p th\u1ee5.<\/li>\n<\/ul>\n<p style=\"text-align: justify\">Thi\u1ebfu h\u1ee5t vitamin D v\u00e0 b\u1ec7nh c\u00f2i x\u01b0\u01a1ng do thi\u1ebfu ch\u1ea5t dinh d\u01b0\u1ee1ng l\u00e0 v\u1ea5n \u0111\u1ec1 s\u1ee9c kh\u1ecfe nhi khoa ch\u00ednh t\u1ea1i \u00dac v\u00e0 New Zealand. Nguy\u00ean nh\u00e2n ch\u1ee7 y\u1ebfu l\u00e0 do gi\u1ea3m s\u1ef1 t\u1ed5ng h\u1ee3p vitamin D. V\u1edbi c\u00e1c c\u00e1 nh\u00e2n c\u00f3 m\u00e0u da t\u1ed1i hay nh\u1eefng ng\u01b0\u1eddi b\u1ecbt k\u00edn c\u01a1 th\u1ec3 khi ra ngo\u00e0i. V\u00ec l\u00fd do v\u0103n h\u00f3a l\u00e0 nh\u1eefng ng\u01b0\u1eddi c\u00f3 nguy c\u01a1 cao nh\u1ea5t. Trong \u00fd ki\u1ebfn th\u1ed1ng nh\u1ea5t n\u00e0y, ch\u00fang t\u00f4i xem x\u00e9t vi\u1ec7c chuy\u1ec3n h\u00f3a vitamin D v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 nguy h\u1ea1i. \u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a vi\u1ec7c thi\u1ebfu h\u1ee5t vitamin D \u1edf tr\u1ebb s\u01a1 sinh, tr\u1ebb nh\u1ecf, thanh thi\u1ebfu ni\u00ean v\u00e0 cung c\u1ea5p c\u00e1c \u0111\u1ec1 xu\u1ea5t cho vi\u1ec7c \u0111i\u1ec1u tr\u1ecb v\u00e0 d\u1ef1 ph\u00f2ng sau \u0111\u00f3.<\/p>\n<h2 id=\"vitamin-d-va-cac-chat-chuyen-hoa\" style=\"text-align: justify\">Vitamin D v\u00e0 c\u00e1c ch\u1ea5t chuy\u1ec3n h\u00f3a<\/h2>\n<p style=\"text-align: justify\">\u201cVitamin D\u201d (calciferol) bao g\u1ed3m c\u1ea3 vitamin D3 (cholecalciferol) v\u00e0 vitamin D2 (ergocalciferol). Vitamin D3 \u0111\u01b0\u1ee3c s\u1ea3n xu\u1ea5t nh\u1edd v\u00e0o t\u00e1c \u0111\u1ed9ng c\u1ee7a \u00e1nh s\u00e1ng tia c\u1ef1c t\u00edm B (UVB; b\u01b0\u1edbc s\u00f3ng, 290-320 nm) l\u00ean 7-dehydrocholesterol \u1edf da c\u1ee7a con ng\u01b0\u1eddi. V\u00e0 l\u00e0 d\u1ea1ng vitamin D \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y trong d\u1ea7u c\u00e1. Vitamin D2 \u0111\u01b0\u1ee3c h\u00ecnh th\u00e0nh khi \u00e1nh s\u00e1ng tia c\u1ef1c t\u00edm chi\u1ebfu l\u00ean ergosterol c\u1ee7a n\u1ea5m. R\u1ea5t \u00edt Vitamin D2 c\u00f3 s\u1eb5n t\u1ef1 nhi\u00ean trong th\u1ef1c ph\u1ea9m. Nh\u01b0ng n\u00f3 l\u00e0 ngu\u1ed3n b\u1ed5 sung vitamin D s\u1eb5n s\u00e0ng nh\u1ea5t.<\/p>\n<p style=\"text-align: justify\">M\u1ed9t khi \u0111\u01b0\u1ee3c t\u1ed5ng h\u1ee3p tr\u00ean da hay ti\u00eau h\u00f3a. Vitamin D \u0111\u01b0\u1ee3c chuy\u1ec3n \u0111\u1ebfn gan v\u00e0 \u0111\u01b0\u1ee3c g\u1eafn 25-hydroxylase tr\u1edf th\u00e0nh 25-hydroxycholecalciferol (25-OHD hay calcidiol). H\u00ecnh th\u1ee9c l\u01b0u th\u00f4ng ch\u00ednh c\u1ee7a vitamin D. N\u1ed3ng \u0111\u1ed9 25-OHD3 trong huy\u1ebft thanh ph\u1ea3n \u00e1nh t\u1ed5ng l\u01b0\u1ee3ng vitamin D l\u01b0u tr\u1eef trong c\u01a1 th\u1ec3. V\u00e0 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 tr\u1ea1ng th\u00e1i vitamin D. \u1ede th\u1eadn, 25-OHD \u0111\u01b0\u1ee3c g\u1eafn th\u00eam 1alpha-hydroxylase tr\u1edf th\u00e0nh 1,25-dihydroxycholecalciferon(1,25- [OH] 2D, ho\u1eb7c calcitriol). Nh\u1eefng t\u00e1c \u0111\u1ed9ng c\u1ee7a 1,25-(OH) 2D l\u00e0: (i) t\u0103ng c\u01b0\u1eddng h\u1ea5p thu canxi v\u00e0 phot-phat t\u1eeb ru\u1ed9t non; (ii) \u0111i\u1ec1u ch\u1ec9nh n\u1ed3ng \u0111\u1ed9 canxi huy\u1ebft thanh, c\u1ea3 tr\u1ef1c ti\u1ebfp v\u00e0 th\u00f4ng qua hormone tuy\u1ebfn c\u1eadn gi\u00e1p; v\u00e0 (iii) th\u00fac \u0111\u1ea9y qu\u00e1 tr\u00ecnh kho\u00e1ng h\u00f3a x\u01b0\u01a1ng<\/p>\n<p style=\"text-align: justify\"><img decoding=\"async\" class=\"aligncenter\" style=\"width: 500px;height: 288px\" src=\"\/\/yhoccongdong.org\/Documents\/2884_chuyn-hoa-calcium-va-photphat.png\" alt=\"Chuy\u1ec3n h\u00f3a calcium v\u00e0 ph\u1ed1t ph\u00e1t\" \/><\/p>\n<h2 id=\"nguon-vitamin-d-o-ec-va-new-zealand\" style=\"text-align: justify\">Ngu\u1ed3n vitamin D \u1edf \u00dac v\u00e0 New Zealand<\/h2>\n<p style=\"text-align: justify\"><strong> \u00c1nh s\u00e1ng m\u1eb7t tr\u1eddi <\/strong><\/p>\n<p style=\"text-align: justify\">Ngu\u1ed3n vitamin D ch\u1ee7 y\u1ebfu (h\u01a1n 80%) \u1edf \u00dac v\u00e0 New Zealand l\u00e0 s\u1ef1 ti\u1ebfp x\u00fac c\u1ee7a da v\u1edbi \u00e1nh n\u1eafng m\u1eb7t tr\u1eddi (b\u1ee9c x\u1ea1 tia c\u1ef1c t\u00edm). Ti\u1ebfp x\u00fac v\u1edbi \u00e1nh n\u1eafng c\u0169ng g\u00e2y n\u00ean 99% ung th\u01b0 da non-melanoma v\u00e0 95% ung th\u01b0 da melanoma \u1edf \u00dac. V\u00ec v\u1eady, c\u1ea7n ph\u1ea3i c\u00f3 c\u00e2n b\u1eb1ng gi\u1eefa vi\u1ec7c ti\u1ebfp x\u00fac \u0111\u1ee7 l\u01b0\u1ee3ng \u00e1nh n\u1eafng m\u1eb7t tr\u1eddi. \u0110\u1ec3 duy tr\u00ec s\u1ea3n xu\u1ea5t l\u01b0\u1ee3ng vitamin D \u0111\u1ea7y \u0111\u1ee7 v\u00e0 gi\u1ea3m nguy c\u01a1 ung th\u01b0 da \u0111\u1ebfn m\u1ee9c t\u1ed1i thi\u1ec3u. Kh\u00f4ng c\u00f3 s\u1eb5n d\u1eef li\u1ec7u nhi khoa \u00dac hay New Zealand \u0111\u1ec1 c\u1eadp \u0111\u1ebfn th\u1eddi gian \u0111\u00f2i h\u1ecfi ti\u1ebfp x\u00fac b\u1ee9c x\u1ea1 tia c\u1ef1c t\u00edm \u0111\u1ec3 duy tr\u00ec m\u1ee9c \u0111\u1ed9 vitamin D c\u1ea7n thi\u1ebft. M\u1eb7c d\u00f9 v\u1eady, m\u1ed9t khuy\u1ebfn c\u00e1o c\u1ee7a \u00dac g\u1ea7n \u0111\u00e2y v\u1ec1 m\u1ed1i nguy h\u1ea1i v\u00e0 l\u1ee3i \u00edch c\u1ee7a vi\u1ec7c ti\u1ebfp x\u00fac \u00e1nh n\u1eafng m\u1eb7t tr\u1eddi. R\u1eb1ng tr\u1ebb em s\u1ebd nh\u1eadn \u0111\u1ee7 l\u01b0\u1ee3ng b\u1ee9c x\u1ea1 tia c\u1ef1c t\u00edm \u0111\u1ec3 duy tr\u00ec l\u01b0\u1ee3ng vitamin D cho s\u1ee9c kh\u1ecfe. N\u1ebfu c\u00e1c v\u00f9ng da nh\u1ecf \u0111\u01b0\u1ee3c ti\u1ebfp x\u00fac v\u1edbi \u00e1nh n\u1eafng tr\u01b0\u1edbc 10 gi\u1edd s\u00e1ng v\u00e0 sau 4 gi\u1edd chi\u1ec1u. Th\u1eadm ch\u00ed s\u1eed d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p ch\u1ed1ng n\u1eafng.<\/p>\n<p style=\"text-align: justify\">D\u1eef li\u1ec7u v\u1ec1 th\u1eddi gian ti\u1ebfp x\u00fac v\u1edbi \u00e1nh n\u1eafng m\u1eb7t tr\u1eddi \u0111\u1ec3 b\u00e0n tay, c\u00e1nh tay v\u00e0 khu\u00f4n m\u1eb7t v\u00e0 s\u1ea3n xu\u1ea5t vitamin D3 d\u00e0nh cho ng\u01b0\u1eddi l\u1edbn g\u1ea7n \u0111\u00e2y \u0111\u00e3 \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1. V\u1edbi t\u1ef7 l\u1ec7 c\u01a1 th\u1ec3 kh\u00e1c nhau \u1edf tr\u1ebb em v\u00e0 vi\u1ec7c gi\u1ea3m kh\u1ea3 n\u0103ng t\u1ed5ng h\u1ee3p vitamin D do l\u00e3o h\u00f3a. Tr\u1ebb em ch\u1eafc h\u1eb3n \u0111\u00f2i h\u1ecfi l\u01b0\u1ee3ng ti\u1ebfp x\u00fac \u00e1nh s\u00e1ng \u00edt h\u01a1n \u0111\u1ec3 s\u1ea3n xu\u1ea5t m\u1ed9t l\u01b0\u1ee3ng vitamin D t\u01b0\u01a1ng \u1ee9ng so v\u1edbi ng\u01b0\u1eddi l\u1edbn. Ngo\u00e0i ra, nh\u1eefng ng\u01b0\u1eddi c\u00f3 nguy c\u01a1 thi\u1ebfu h\u1ee5t vitamin D cao nh\u1ea5t trong c\u1ed9ng \u0111\u1ed3ng ch\u00fang ta. Nh\u1eefng c\u00e1 nh\u00e2n t\u0103ng s\u1eafc t\u1ed1 da- c\u00f3 th\u1ec3 \u0111\u00f2i h\u1ecfi l\u01b0\u1ee3ng ti\u1ebfp x\u00fac \u00e1nh s\u00e1ng m\u1eb7t tr\u1eddi g\u1ea5p 6 l\u1ea7n. \u0110\u1ec3 c\u00f3 \u0111\u01b0\u1ee3c m\u1ee9c t\u0103ng n\u1ed3ng \u0111\u1ed9 vitamin D nh\u01b0 v\u1edbi c\u00e1 nh\u00e2n c\u00f3 l\u00e0n da s\u00e1ng m\u00e0u. Th\u1ee7y tinh v\u00e0 kem ch\u1ed1ng n\u1eafng h\u1ea5p th\u1ee5 b\u1ee9c x\u1ea1 UVB, l\u00e0m gi\u1ea3m qu\u00e1 tr\u00ecnh s\u1ea3n xu\u1ea5t vitamin D3. V\u00e0 c\u00f3 th\u1ec3 l\u00e0m t\u0103ng kh\u1ea3 n\u0103ng x\u1ea3y ra t\u00ecnh tr\u1ea1ng thi\u1ebfu h\u1ee5t vitamin D. \u0110\u1eb7c bi\u1ec7t \u1edf ng\u01b0\u1eddi c\u00f3 s\u1eafc t\u1ed1 da t\u1ed1i m\u00e0u.<\/p>\n<h2 id=\"che-do-an-uong\" style=\"text-align: justify\">Ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng<\/h2>\n<p style=\"text-align: justify\">N\u1ed3ng \u0111\u1ed9 vitamin D \u1edf tr\u1ebb s\u01a1 sinh ph\u1ea3n \u00e1nh tr\u1ea1ng th\u00e1i vitamin D c\u1ee7a ng\u01b0\u1eddi m\u1eb9. N\u1ebfu ng\u01b0\u1eddi m\u1eb9 \u0111\u1ea7y \u0111\u1ee7 vitamin D th\u00ec \u0111\u1ee9a tr\u1ebb s\u01a1 sinh s\u1ebd d\u1ef1 tr\u1eef \u0111\u01b0\u1ee3c l\u01b0\u1ee3ng vitamin D t\u1eeb 8 \u0111\u1ebfn 12 tu\u1ea7n. 1 l\u00edt s\u1eefa t\u1eeb ng\u01b0\u1eddi ph\u1ee5 n\u1eef c\u00f3 \u0111\u1ea7y \u0111\u1ee7 vitamin D ch\u1ec9 ch\u1ee9a n\u1ed3ng \u0111\u1ed9 vitamin D l\u00e0 25 IU (&lt;1 \u03bcg). H\u1ea7u h\u1ebft s\u1eefa c\u00f4ng th\u1ee9c d\u00e0nh cho tr\u1ebb em \u0111\u01b0\u1ee3c qu\u1ea3ng c\u00e1o t\u1ea1i \u00dac v\u00e0 New Zealand ch\u1ee9a 400 IU (10 \u03bcg) vitamin D3\/l\u00edt. V\u00ec th\u1ebf m\u1ed9t l\u01b0\u1ee3ng 500 ml s\u1eefa c\u00f4ng th\u1ee9c m\u1ed7i ng\u00e0y cung c\u1ea5p cho b\u00e9 200 IU (\u03bcg) vitamin D. L\u00e0 l\u01b0\u1ee3ng v\u1eeba \u0111\u1ee7 cho gi\u00fap tr\u1ebb s\u01a1 sinh v\u00e0 tr\u1ebb nh\u1ecf kh\u1ecfe m\u1ea1nh \u0111\u01b0\u1ee3c Vi\u1ec7n h\u00e0n l\u00e2m Nhi khoa Hoa K\u1ef3 khuy\u1ebfn c\u00e1o. S\u1eefa gi\u00fap b\u1ed5 sung vitamin D3 (l\u00ean \u0111\u1ebfn 200 IU m\u1ed7i 250 mL) g\u1ea7n \u0111\u00e2y \u0111\u00e3 c\u00f3 s\u1eb5n.<\/p>\n<p style=\"text-align: justify\">Tuy nhi\u00ean, l\u01b0\u1ee3ng vitamin D trung b\u00ecnh h\u1eb1ng ng\u00e0y d\u00e0nh cho ng\u01b0\u1eddi l\u1edbn \u1edf \u00dac t\u1eeb d\u1ea7u c\u00e1, tr\u1ee9ng v\u00e0 b\u01a1 hay b\u01a1 th\u1ef1c v\u1eadt ch\u1ec9 ch\u1ee9a 50-100 IU (1,2-2,6 \u03bcg). V\u00ec v\u1eady n\u1ebfu kh\u00f4ng c\u00f3 s\u1ef1 ti\u1ebfp x\u00fac v\u1edbi \u00e1nh n\u1eafng m\u1eb7t tr\u1eddi. H\u1ea5p th\u1ee5 s\u1eefa b\u1ed5 sung vitamin D hay c\u00e1c ch\u1ea5t b\u1ed5 sung vitamin D th\u00ec th\u1eadt kh\u00f3 cho c\u00e1c b\u00e0 m\u1eb9 mang thai v\u00e0 \u0111ang cho con b\u00fa, tr\u1ebb b\u00fa s\u1eefa m\u1eb9 hay tr\u1ebb em \u0111\u1ea1t \u0111\u01b0\u1ee3c l\u01b0\u1ee3ng vitamin D \u0111\u1ea7y \u0111\u1ee7 h\u1eb1ng ng\u00e0y khi n\u1ebfu ch\u1ec9 nh\u1edd v\u00e0o ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng.<\/p>\n<h2 id=\"dinh-nghia-thieu-hut-vitamin-d\" style=\"text-align: justify\">\u0110\u1ecbnh ngh\u0129a thi\u1ebfu h\u1ee5t vitamin D<\/h2>\n<p style=\"text-align: justify\">N\u1ed3ng \u0111\u1ed9 25-OHD trong huy\u1ebft thanh cung c\u1ea5p c\u00e1c ch\u1ec9 s\u1ed1 t\u1ed1t nh\u1ea5t v\u1ec1 tr\u1ea1ng th\u00e1i vitamin D. V\u00e0 n\u00ean s\u1eed d\u1ee5ng khi ki\u1ec3m tra t\u00ecnh tr\u1ea1ng thi\u1ebfu h\u1ee5t (n\u1ed3ng \u0111\u1ed9 b\u00ecnh th\u01b0\u1eddng,&gt; 50 nmol\/L). Kh\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng n\u1ed3ng \u0111\u1ed9 1,25-(OH)2D. V\u00ec n\u00f3 c\u00f3 th\u1ec3 t\u0103ng l\u00ean ngay c\u1ea3 trong t\u00ecnh tr\u1ea1ng thi\u1ebfu vitamin D tr\u1ea7m tr\u1ecdng. C\u00e1c x\u00e9t nghi\u1ec7m 25-OHD kh\u00e1c nhau cho k\u1ebft qu\u1ea3 kh\u00e1c nhau. V\u1edbi m\u1ed9t s\u1ed1 kh\u00f4ng \u0111\u1ecbnh l\u01b0\u1ee3ng \u0111\u01b0\u1ee3c Vitamin D2 (ergocalciferol) c\u0169ng nh\u01b0 Vitamin D3 (cholecalciferol). \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn k\u1ebft qu\u1ea3 gi\u1ea3 gi\u1ea3m n\u1ed3ng \u0111\u1ed9 25-OHD \u1edf tr\u1ebb em c\u00f3 b\u1ed5 sung vitamin D2<\/p>\n<p style=\"text-align: justify\"><em> <strong> Thi\u1ebfu vitamin D \u1edf m\u1ee9c \u0111\u1ed9 nh\u1eb9: <\/strong> <\/em> N\u1ed3ng \u0111\u1ed9 25-OHD trong huy\u1ebft thanh l\u00e0 25-50 nmol\/L. N\u1ed3ng \u0111\u1ed9 tr\u00ean 50 nmol\/L tr\u00e1nh \u0111\u01b0\u1ee3c ch\u1ee9ng c\u01b0\u1eddng c\u1eadn gi\u00e1p th\u1ee9 ph\u00e1t v\u00e0 m\u1ee9c \u0111\u1ed9 phot-pho ki\u1ec1m cao.<\/p>\n<p style=\"text-align: justify\"><em> <strong> Thi\u1ebfu vitamin D \u1edf m\u1ee9c \u0111\u1ed9 v\u1eeba ph\u1ea3i: <\/strong> <\/em> n\u1ed3ng \u0111\u1ed9 25-OHD trong huy\u1ebft thanh l\u00e0 12,5-25 nmol\/L. T\u1ef7 l\u1ec7 m\u1eafc h\u1ea1 canxi m\u00e1u v\u00e0 b\u1ec7nh c\u00f2i x\u01b0\u01a1ng t\u0103ng l\u00ean c\u00f9ng v\u1edbi s\u1ef1 thi\u1ebfu h\u1ee5t v\u1eeba ph\u1ea3i.<\/p>\n<p style=\"text-align: justify\"><strong> <em> Thi\u1ebfu h\u1ee5t vitamin D tr\u1ea7m tr\u1ecdng: <\/em> <\/strong> N\u1ed3ng \u0111\u1ed3 25-OHD trong huy\u1ebft thanh nh\u1ecf h\u01a1n 12,5 nmol\/L. N\u1ed3ng \u0111\u1ed3 vitamin D nh\u1ecf h\u01a1n 12,5 nmol\/L \u0111\u01b0\u1ee3c th\u1ea5y \u1edf h\u01a1n 70% tr\u1ebb em m\u1eafc b\u1ec7nh c\u00f2i x\u01b0\u01a1ng v\u00e0 h\u01a1n 90% tr\u1ebb em b\u1ecb h\u1ea1 canxi m\u00e1u.<\/p>\n<p style=\"text-align: justify\">Vitamin D l\u00e0 m\u1ed9t hormone steroid c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong ho\u1ea1t \u0111\u1ed9ng sinh l\u00fd. Ngo\u00e0i vi\u1ec7c c\u00e2n b\u1eb1ng kho\u00e1ng, c\u00f2n\u00a0g\u00f3p ph\u1ea7n\u00a0v\u00e0o qu\u00e1 tr\u00ecnh ph\u00e2n chia v\u00e0 tr\u01b0\u1edfng th\u00e0nh\u00a0t\u1ebf b\u00e0o, v\u00e0 ch\u1ee9c n\u0103ng mi\u1ec5n d\u1ecbch. Do \u0111\u00f3, vi\u1ec7c ch\u1ec9 x\u00e1c \u0111\u1ecbnh vitamin D \u0111\u1ea7y \u0111\u1ee7 tr\u00ean c\u01a1 s\u1edf c\u00e2n b\u1eb1ng canxi v\u00e0 x\u01b0\u01a1ng. Kh\u00f4ng th\u1ec3 ph\u1ea3n \u00e1nh t\u1ea5t c\u1ea3 c\u00e1c t\u00e1c \u0111\u1ed9ng ti\u1ec1m t\u00e0ng c\u1ee7a n\u00f3.<\/p>\n<p style=\"text-align: justify\"><strong> Tr\u1ebb s\u01a1 sinh v\u00e0 tr\u1ebb nh\u1ecf c\u00f3 nguy c\u01a1 thi\u1ebfu h\u1ee5t vitamin D <\/strong><\/p>\n<p style=\"text-align: justify\">Nh\u1eefng kh\u1ea3o s\u00e1t nghi\u00ean c\u1ee9u hi\u1ec7n nay c\u1ee7a \u0110\u01a1n v\u1ecb Gi\u00e1m s\u00e1t Khoa Nhi \u1edf \u00dac v\u00e0 New Zealand (APSU v\u00e0 NZPSU) v\u1ec1 t\u1ef7 l\u1ec7 hi\u1ec7n m\u1eafc v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 \u0111\u1ed1i v\u1edbi b\u1ec7nh c\u00f2i x\u01b0\u01a1ng do thi\u1ebfu vitamin D. S\u1ebd c\u1ea3i thi\u1ec7n s\u1ef1 hi\u1ec3u bi\u1ebft c\u1ee7a ch\u00fang ta v\u1ec1 vi\u1ec7c thi\u1ebfu h\u1ee5t vitamin D \u1edf tr\u1ebb em. T\u1eeb c\u00e1c d\u1eef li\u1ec7u hi\u1ec7n t\u1ea1i, y\u1ebfu t\u1ed1 nguy c\u01a1 li\u00ean quan \u0111\u1ebfn thi\u1ebfu h\u1ee5t vitamin D \u1edf tr\u1ebb s\u01a1 sinh v\u00e0 tr\u1ebb em. C\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c chia th\u00e0nh ba khu v\u1ef1c l\u1edbn (b\u1ea3ng 1). C\u00f3 v\u1ebb nh\u01b0 l\u00e0 nhi\u1ec1u y\u1ebfu t\u1ed1 \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y trong c\u00f9ng m\u1ed9t c\u00e1 nh\u00e2n. V\u00ed d\u1ee5, nh\u1eefng ng\u01b0\u1eddi nh\u1eadp c\u01b0 g\u1ea7n \u0111\u00e2y t\u1eeb ch\u00e2u Phi v\u00e0 Trung \u0110\u00f4ng \u0111ang c\u00f3 nguy c\u01a1 thi\u1ebfu vitamin D do m\u00e0u da t\u1ed1i, kh\u00f4ng \u0111\u1ee7 dinh d\u01b0\u1ee1ng, gi\u1ea3m ti\u1ebfp x\u00fac v\u1edbi \u00e1nh s\u00e1ng m\u1eb7t tr\u1eddi v\u00e0 cho con b\u00fa k\u00e9o d\u00e0i.<\/p>\n<h2 id=\"dac-diem-cua-viec-thieu-hut-vitamin-d\" style=\"text-align: justify\">\u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a vi\u1ec7c thi\u1ebfu h\u1ee5t vitamin D<\/h2>\n<p style=\"text-align: justify\">Thi\u1ebfu h\u1ee5t vitamin D c\u00f3 c\u1ea3 di ch\u1ee9ng \u1edf x\u01b0\u01a1ng v\u00e0 kh\u00f4ng \u1edf x\u01b0\u01a1ng (b\u1ea3ng 2). \u0110\u01b0\u1ee3c nh\u1eadn th\u1ea5y nhi\u1ec1u nh\u1ea5t l\u00e0 nh\u1eefng bi\u1ebfn ch\u1ee9ng x\u01b0\u01a1ng c\u1ee7a b\u1ec7nh c\u00f2i x\u01b0\u01a1ng v\u00e0 lo\u00e3ng x\u01b0\u01a1ng. K\u1ebft qu\u1ea3 c\u1ee7a b\u1ec7nh c\u00f2i x\u01b0\u01a1ng l\u00e0 do thi\u1ebfu kho\u00e1ng x\u01b0\u01a1ng \u1edf khu v\u1ef1c gi\u00e1p v\u1edbi s\u1ee5n t\u0103ng tr\u01b0\u1edfng. V\u00e0 lo\u00e3ng x\u01b0\u01a1ng do thi\u1ebfu kho\u00e1ng x\u01b0\u01a1ng t\u1ea1i c\u00e1c \u0111i\u1ec3m c\u1ee7a m\u00f4 h\u00ecnh x\u01b0\u01a1ng v\u00e0 t\u00e1i m\u00f4 h\u00ecnh x\u01b0\u01a1ng. Trong khi b\u1ec7nh c\u00f2i x\u01b0\u01a1ng hay g\u1eb7p trong qu\u00e1 tr\u00ecnh t\u0103ng tr\u01b0\u1edfng. V\u1edbi t\u1ef7 l\u1ec7 cao nh\u1ea5t trong th\u1eddi k\u1ef3 t\u0103ng tr\u01b0\u1edfng nhanh \u1edf giai \u0111o\u1ea1n c\u00f2n nh\u1ecf v\u00e0 d\u1eady th\u00ec s\u1edbm. Ch\u1ee9ng nhuy\u1ec5n x\u01b0\u01a1ng ph\u1ed5 bi\u1ebfn \u1edf c\u1ea3 tr\u1ebb em v\u00e0 ng\u01b0\u1eddi l\u1edbn.<\/p>\n<p style=\"text-align: justify\">Nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a thi\u1ebfu h\u1ee5t vitamin D kh\u00f4ng li\u00ean quan \u0111\u1ebfn x\u01b0\u01a1ng. Bao g\u1ed3m b\u1ec7nh gi\u00e3n c\u01a1 tim v\u00e0 x\u01a1 t\u1ee7y v\u1edbi vi\u1ec7c gi\u1ea3m to\u00e0n th\u1ec3 huy\u1ebft c\u1ea7u hay thi\u1ebfu m\u00e1u h\u1ed3ng c\u1ea7u. H\u00e3y l\u01b0u \u00fd \u0111\u1ebfn vi\u1ec7c thi\u1ebfu h\u1ee5t vitamin D v\u00e0 s\u1eaft c\u00f9ng l\u00fac. C\u00e1c ch\u1ee9c n\u0103ng li\u00ean quan kh\u00e1c bao g\u1ed3m suy gi\u1ea3m ch\u1ee9c n\u0103ng mi\u1ec5n d\u1ecbch, s\u1ef1 bi\u1ec7t h\u00f3a v\u00e0 t\u0103ng sinh t\u1ebf b\u00e0o, v\u00e0 b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng lo\u1ea1i 1.<\/p>\n<h2 id=\"dac-diem-sinh-hoa-cua-viec-thieu-hut-vitamin-d\" style=\"text-align: justify\">\u0110\u1eb7c \u0111i\u1ec3m sinh h\u00f3a c\u1ee7a vi\u1ec7c thi\u1ebfu h\u1ee5t vitamin D<\/h2>\n<p style=\"text-align: justify\">Thi\u1ebfu h\u1ee5t vitamin D d\u1eabn \u0111\u1ebfn ch\u1ee9ng h\u1ea1 canxi m\u00e1u, c\u01b0\u1eddng c\u1eadn gi\u00e1p th\u1ee9 c\u1ea5p, thi\u1ebfu phot-phat m\u00e1u v\u00e0 t\u0103ng phot-phat ki\u1ec1m. Trong \u0111\u00f3 phot-phat ki\u1ec1m t\u0103ng l\u00e0 th\u01b0\u1eddng g\u1eb7p nh\u1ea5t. Tr\u1ebb s\u01a1 sinh th\u01b0\u1eddng xuy\u00ean b\u1ecb h\u1ea1 canxi m\u00e1u tr\u1ea7m tr\u1ecdng v\u00e0 c\u01b0\u1eddng c\u1eadn gi\u00e1p th\u1ee9 c\u1ea5p c\u00f3 n\u1ed3ng \u0111\u1ed9 phot-phat trong huy\u1ebft thanh b\u00ecnh th\u01b0\u1eddng ho\u1eb7c t\u0103ng cao. Cho th\u1ea5y hi\u1ec7n t\u01b0\u1ee3ng kh\u00e1ng n\u1ed9i ti\u1ebft t\u1ed1 c\u1eadn gi\u00e1p \u1edf c\u1ea3 c\u1ea5p \u0111\u1ed9 x\u01b0\u01a1ng v\u00e0 th\u1eadn do thi\u1ebfu h\u1ee5t vitamin D k\u00e9o d\u00e0i. \u00a0\u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 g\u00e2y nh\u1ea7m l\u1eabn v\u1edbi suy tuy\u1ebfn c\u1eadn gi\u00e1p v\u00e0 gi\u1ea3m n\u0103ng tuy\u1ebfn c\u1eadn gi\u00e1p gi\u1ea3. Do k\u1ebft qu\u1ea3 n\u1ed3ng \u0111\u1ed9 phot-phat v\u00e0 canxi trong huy\u1ebft thanh th\u01b0\u1eddng xuy\u00ean x\u1ea3y ra tr\u01b0\u1edbc vitamin D v\u00e0 n\u1ed9i ti\u1ebft t\u1ed1 c\u1eadn gi\u00e1p. N\u1ed3ng \u0111\u1ed9 calcitriol (1,25-[OH]2D) c\u00f3 th\u1ec3 th\u1ea5p, b\u00ecnh th\u01b0\u1eddng ho\u1eb7c cao t\u1ea1i th\u1eddi \u0111i\u1ec3m ch\u1ea9n \u0111o\u00e1n, v\u00e0 ch\u00fang kh\u00f4ng c\u00f3 gi\u00e1 tr\u1ecb trong vi\u1ec7c ch\u1ea9n \u0111o\u00e1n.<\/p>\n<h2 id=\"kien-nghi-dieu-tri-thieu-hut-vitamin-d-tu-trung-binh-den-thieu-hut-tram-trong\" style=\"text-align: justify\">Ki\u1ebfn ngh\u1ecb \u0111i\u1ec1u tr\u1ecb thi\u1ebfu h\u1ee5t vitamin D t\u1eeb trung b\u00ecnh \u0111\u1ebfn thi\u1ebfu h\u1ee5t tr\u1ea7m tr\u1ecdng<\/h2>\n<p style=\"text-align: justify\">C\u1ea3 ergocalciferol (25-OHD2) v\u00e0 cholecalciferol (25-OHD3) \u0111\u1ec1u l\u00e0 li\u1ec7u ph\u00e1p hi\u1ec7u qu\u1ea3 \u0111\u1ed1i v\u1edbi vi\u1ec7c thi\u1ebfu h\u1ee5t vitamin D. V\u1edbi l\u01b0\u1ee3ng ergocalciferol lu\u00f4n \u0111\u01b0\u1ee3c chu\u1ea9n b\u1ecb s\u1eb5n nhi\u1ec1u nh\u1ea5t (b\u1ea3ng 3). Vi\u1ec7c b\u1ed5 sung vitamin D \u0111\u00f2i h\u1ecfi t\u1ed5ng m\u1ed9t li\u1ec1u vitamin D l\u00e0 100 000 -500 000 IU, ph\u1ee5 thu\u1ed9c v\u00e0o \u0111\u1ed9 tu\u1ed5i (b\u1ea3ng 3). \u0110i\u1ec1u tr\u1ecb b\u1eb1ng calcitriol (1,25-[OH]2D) ch\u1ec9 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u1ed1i v\u1edbi h\u1ea1 canxi m\u00e1u (xem b\u00ean d\u01b0\u1edbi). Khuy\u1ebfn c\u00e1o b\u1ed5 sung canxi n\u1ebfu ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7 (b\u1ea3ng 4). N\u00ean l\u01b0u \u00fd r\u1eb1ng vi\u1ec7c thi\u1ebfu h\u1ee5t vitamin do \u0103n u\u1ed1ng l\u00e0 nguy c\u01a1 ch\u00ednh \u0111\u1ed1i v\u1edbi s\u1ef1 ph\u00e1t tri\u1ec3n b\u1ec7nh c\u00f2i x\u01b0\u01a1ng \u1edf ng\u01b0\u1eddi ngh\u00e8o. V\u00e0 n\u00ean xem x\u00e9t trong c\u1ed9ng \u0111\u1ed3ng d\u00e2n nh\u1eadp c\u01b0. N\u1ebfu b\u1ec7nh thi\u1ebfu vitamin D hay c\u00f2i x\u01b0\u01a1ng v\u1eabn kh\u00f4ng gi\u1ea3i quy\u1ebft \u0111\u01b0\u1ee3c sau khi \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7y \u0111\u1ee7. N\u00ean t\u00ecm hi\u1ec3u ch\u1ee9ng r\u1ed1i lo\u1ea1n do h\u1ea5p th\u1ee5 k\u00e9m (v\u00ed d\u1ee5 nh\u01b0 b\u1ec7nh coeliac)\u00a0 hay ch\u1ee9ng r\u1ed1i lo\u1ea1n c\u00f2i x\u01b0\u01a1ng di truy\u1ec1n (v\u00ed d\u1ee5 nh\u01b0 c\u00f2i x\u01b0\u01a1ng do thi\u1ebfu phot-phat trong m\u00e1u) \u1edf tr\u1ebb em.<\/p>\n<p style=\"text-align: justify\">H\u1eadu qu\u1ea3 nghi\u00eam tr\u1ecdng nh\u1ea5t do thi\u1ebfu h\u1ee5t vitamin D l\u00e0 co gi\u1eadt do h\u1ea1 canxi m\u00e1u. Trong khi ph\u1ed5 bi\u1ebfn nh\u1ea5t l\u00e0 \u1edf tr\u1ebb s\u01a1 sinh d\u01b0\u1edbi 6 th\u00e1ng tu\u1ed5i, co gi\u1eadt c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf b\u1ea5t k\u00ec \u0111\u1ed9 tu\u1ed5i n\u00e0o. Ti\u00eam canxi v\u00e0o t\u0129nh m\u1ea1ch \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb co gi\u1eadt v\u00e0 co c\u1ee9ng kh\u1edbp x\u01b0\u01a1ng b\u00e0n tay b\u00e0n ch\u00e2n. Vi\u1ec7c truy\u1ec1n canxi c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem x\u00e9t n\u1ebfu kh\u00f4ng \u0111\u1ea1t \u0111i\u1ec1u tr\u1ecb v\u1edbi 1 \u0111\u1ebfn 2 li\u1ec1u cao(b\u1ea3ng 3). C\u1ea7n ph\u1ea3i c\u1ea9n th\u1eadn khi ti\u1ec1m canxi v\u00e0o t\u0129nh m\u1ea1ch. V\u00ec s\u1ef1 tho\u00e1t m\u1ea1ch s\u1ebd d\u1eabn \u0111\u1ebfn b\u1ecfng h\u00f3a ch\u1ea5t nghi\u00eam tr\u1ecdng cho da v\u00e0 m\u00f4 d\u01b0\u1edbi da. M\u1eb7c d\u00f9 c\u00f3 th\u1ec3 l\u1eadp lu\u1eadn r\u1eb1ng l\u01b0\u1ee3ng 1,25-(OH)2D s\u1ea3n sinh ra sau khi ti\u00eam 25-OHD s\u1ebd \u0111\u1ee7 \u0111\u1ec3 kh\u1ed1ng ch\u1ebf h\u1ea1 canxi m\u00e1u. \u00dd ki\u1ebfn c\u1ee7a ch\u00fang t\u00f4i l\u00e0 calcitriol ho\u1eb7c 1\u03b1-hydroxyvitamin D3 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c d\u00f9ng chung cho \u0111\u1ebfn khi n\u1ed3ng \u0111\u1ed9 canxi trong huy\u1ebft thanh n\u1eb1m trong gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng. Tr\u1ebb em c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i ch\u1eb7t ch\u1ebd cho \u0111\u1ebfn khi n\u1ed3ng \u0111\u1ed9 canxi trong huy\u1ebft thanh cao h\u01a1n 1.8 nmol\/L.<\/p>\n<p style=\"text-align: justify\">Trong khi thi\u1ebfu h\u1ee5t vitamin D l\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t g\u00e2y h\u1ea1 canxi m\u00e1u sau 4 ng\u00e0y tu\u1ed5i \u0111\u1ea7u. C\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c bao g\u1ed3m qu\u00e1 nhi\u1ec1u phot-phat trong ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng, n\u1ed3ng \u0111\u1ed9 magie trong m\u00e1u th\u1ea5p, suy tuy\u1ebfn c\u1eadn gi\u00e1p nh\u1ea5t th\u1eddi, kh\u00e1ng PTH nh\u1ea5t th\u1eddi v\u00e0 suy tuy\u1ebfn c\u1eadn gi\u00e1p b\u1ea9m sinh. V\u00ec th\u1ebf, n\u1ed3ng \u0111\u1ed9 PTH v\u00e0 magie n\u00ean \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 trong su\u1ed1t qu\u00e1 tr\u00ecnh kh\u00e1m h\u1ea1 canxi m\u00e1u \u1edf tr\u1ebb em.<\/p>\n<h2 id=\"lieu-phap-stoss\" style=\"text-align: justify\">Li\u1ec7u ph\u00e1p Stoss<\/h2>\n<p style=\"text-align: justify\">Li\u1ec7u ph\u00e1p d\u00f9ng vitamin D li\u1ec1u cao (li\u1ec7u ph\u00e1p Stoss) l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p hi\u1ec7u qu\u1ea3 \u0111\u1ed1i v\u1edbi vi\u1ec7c \u0111i\u1ec1u tr\u1ecb thi\u1ebfu h\u1ee5t vitamin D. Vi\u1ec7c n\u00e0y bao g\u1ed3m ti\u00eam ho\u1eb7c u\u1ed1ng t\u1ed5ng li\u1ec1u vitamin D cho vi\u1ec7c \u0111i\u1ec1u tr\u1ecb (cholecalciferol hay ergocalciferol), 300 000 IU (7500 \u03bcg) \u0111\u1ebfn 500 000 IU (12 500 \u03bcg), ch\u1ec9 m\u1ed9t li\u1ec1u \u0111\u01a1n ho\u1eb7c c\u00f3 th\u1ec3 chia th\u00e0nh 2 \u0111\u1ebfn 4 li\u1ec1u. Kho\u1ea3ng th\u1eddi gian gi\u1eefa c\u00e1c li\u1ec1u c\u00f3 th\u1ec3 thay \u0111\u1ed5i t\u1eeb v\u00e0i ng\u00e0y cho \u0111\u1ebfn v\u00e0i tu\u1ea7n ph\u1ee5 thu\u1ed9c v\u00e0o k\u1ebf ho\u1ea1ch theo d\u00f5i. C\u00f3 r\u1ea5t nhi\u1ec1u ph\u00e1c \u0111\u1ed3 tr\u1ecb li\u1ec7u stoss, v\u00e0 vi\u1ec7c nghi\u00ean c\u1ee9u th\u00eam l\u00e0 r\u1ea5t c\u1ea7n thi\u1ebft \u0111\u1ec3 ho\u00e0n thi\u1ec7n ph\u00e1c \u0111\u1ed3 hi\u1ec7u qu\u1ea3 nh\u1ea5t v\u00e0 \u0111\u1ea3m b\u1ea3o an to\u00e0n.<\/p>\n<p style=\"text-align: justify\">\u1ede \u00dac, vitamin D c\u00f4 \u0111\u1eb7c kh\u00f4ng c\u00f3 s\u1eb5n l\u00e0m h\u1ea1n ch\u1ebf vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng li\u1ec7u ph\u00e1p stoss. \u1ede New Zealand, li\u1ec1u Calciferol m\u1ea1nh (500 000 IU cholecalciferol; ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe PSM, \u1edf Auckland, NewZealand) \u2013 chu\u1ea9n b\u1ecb li\u1ec1u u\u1ed1ng- l\u00e0 c\u00f3 s\u1eb5n. Ti\u00eam vitamin D li\u1ec1u cao v\u00e0o c\u01a1 b\u1eafp \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb thi\u1ebfu h\u1ee5t vitamin D hi\u1ec7u qu\u1ea3 h\u01a1n l\u00e0 v\u1edbi vi\u1ec7c h\u1ea5p thu k\u00e9m nh\u01b0ng n\u00f3 kh\u00f4ng c\u00f3 s\u1eb5n \u1edf \u00dac v\u00e0 New Zealand. \u0110\u1ec3 thu\u1eadn l\u1ee3i trong vi\u1ec7c s\u1eed d\u1ee5ng li\u1ec7u ph\u00e1p stoss, \u0111\u00f2i h\u1ecfi ph\u1ea3i \u0111a d\u1ea1ng h\u00f3a c\u00e1c lo\u1ea1i ch\u1ebf ph\u1ea9m vitamin D \u1edf \u00dac v\u00e0 New Zealand.<\/p>\n<h2 id=\"du-phong-thieu-hut-vitamin-d\" style=\"text-align: justify\">D\u1ef1 ph\u00f2ng thi\u1ebfu h\u1ee5t vitamin D<\/h2>\n<p style=\"text-align: justify\"><strong> Tr\u1ebb s\u01a1 sinh (&lt;12 th\u00e1ng tu\u1ed5i) <\/strong><\/p>\n<p style=\"text-align: justify\">Nh\u00e2n t\u1ed1 quan tr\u1ecdng nh\u1ea5t trong vi\u1ec7c ph\u00e1t tri\u1ec3n s\u1ef1 thi\u1ebfu h\u1ee5t vitamin D \u1edf tr\u1ebb s\u01a1 sinh l\u00e0 t\u00ecnh tr\u1ea1ng vitamin D \u1edf ng\u01b0\u1eddi m\u1eb9. T\u1ea5t c\u1ea3 ph\u1ee5 n\u1eef mang thai, \u0111\u1eb7c bi\u1ec7t l\u00e0 ng\u01b0\u1eddi m\u1eb9 th\u01b0\u1eddng che k\u00edn m\u1eb7t hay c\u00f3 m\u00e0u da t\u1ed1i n\u00ean ki\u1ec3m tra n\u1ed3ng \u0111\u1ed9 25-OHD trong huy\u1ebft thanh trong su\u1ed1t 3 th\u00e1ng \u0111\u1ea7u th\u1eddi k\u00ec mang thai. N\u1ebfu t\u00ecnh tr\u1ea1ng thi\u1ebfu h\u1ee5t vitamin D n\u1eb1m trong m\u1ee9c v\u1eeba ph\u1ea3i \u0111\u1ebfn nghi\u00eam tr\u1ecdng, ph\u1ee5 n\u1eef mang thai n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi li\u1ec1u t\u1eeb 3000 \u0111\u1ebfn 5000 IU h\u1eb1ng ng\u00e0y cho \u0111\u1ebfn khi n\u1ed3ng \u0111\u1ed9 25-OHD trong huy\u1ebft thanh l\u1edbn h\u01a1n 50nmol\/L. Nh\u1eefng ch\u1ebf ph\u1ea9m n\u00e0y kh\u00f4ng n\u00ean ch\u1ee9a vitamin A v\u00ec c\u00f3 th\u1ec3 g\u00e2y ng\u1ed9 \u0111\u1ed9c cho thai nhi. Sau khi \u0111\u1ea1t \u0111\u01b0\u1ee3c n\u1ed3ng \u0111\u1ed9 n\u00e0y trong huy\u1ebft thanh, ph\u1ee5 n\u1eef mang thai v\u00e0 ph\u1ee5 n\u1eef thi\u1ebfu h\u1ee5t nh\u1eb9 n\u00ean b\u1ed5 sung 400 IU h\u00e0ng ng\u00e0y. B\u1ed5 sung vitamin D th\u01b0\u1eddng xuy\u00ean \u0111\u1ed1i v\u1edbi t\u1ea5t c\u1ea3 ph\u1ee5 n\u1eef mang thai v\u1eabn c\u00f2n l\u00e0 v\u1ea5n \u0111\u1ec1 g\u00e2y tranh c\u00e3i v\u00e0 cho \u0111\u1ebfn khi d\u1eef li\u1ec7u v\u1ec1 t\u1ea7n su\u1ea5t thi\u1ebfu h\u1ee5t vitamin D \u0111\u01b0\u1ee3c \u0111\u01b0a ra th\u00ec \u0111i\u1ec1u n\u00e0y kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn kh\u00edch.<\/p>\n<p style=\"text-align: justify\">Ch\u00fang t\u00f4i khuy\u1ebfn kh\u00edch t\u1ea5t c\u1ea3 tr\u1ebb s\u01a1 sinh b\u00fa s\u1eefa m\u1eb9. Tuy nhi\u00ean, s\u1eefa m\u1eb9 ch\u1ee9a r\u1ea5t \u00edt vitamin D. Vi\u1ec7n H\u00e0n l\u00e2m khoa nhi Hoa K\u1ef3 khuy\u1ebfn c\u00e1o n\u00ean b\u1ed5 sung m\u1ed9t l\u01b0\u1ee3ng 500mL s\u1eefa c\u00f4ng th\u1ee9c ch\u1ee9a vitamin D m\u1ed7i ng\u00e0y \u0111\u1ed1i v\u1edbi t\u1ea5t c\u1ea3 tr\u1ebb s\u01a1 sinh cho \u0111\u1ebfn khi tr\u1ebb cai s\u1eefa. Trong khi \u00dac v\u00e0 New Zealand kh\u00f4ng \u0111\u01b0a ra nh\u1eefng khuy\u1ebfn ngh\u1ecb t\u01b0\u01a1ng t\u1ef1 v\u1eady cho \u0111\u1ebfn khi d\u1eef li\u1ec7u v\u1ec1 t\u00ecnh tr\u1ea1ng vitamin D cho th\u1ea5y tr\u1ebb s\u01a1 sinh c\u00f3 \u201cnguy c\u01a1 th\u1ea5p\u201d. Tr\u1ebb s\u01a1 sinh c\u1ee7a c\u00e1c b\u00e0 m\u1eb9 che k\u00edn m\u1eb7t hay c\u00f3 m\u00e0u da t\u1ed1i n\u00ean \u0111\u01b0\u1ee3c b\u1ed5 sung m\u1ed9t l\u01b0\u1ee3ng 400 IU vitamin D h\u1eb1ng ng\u00e0y (v\u00ed d\u1ee5 0,45 mL Pentavite, theo s\u1ee9c kh\u1ecfe ng\u01b0\u1eddi ti\u00eau d\u00f9ng Roche, Sydney, NSW) cho \u0111\u1ebfn khi \u00edt nh\u1ea5t l\u00e0 12 th\u00e1ng tu\u1ed5i. C\u00e1c ch\u1ebf ph\u1ea9m vitamin D kh\u00e1c c\u00f3 th\u1ec3 c\u00f3 s\u1eb5n t\u1ea1i nh\u00e0 thu\u1ed1c b\u1ec7nh vi\u1ec7n.<\/p>\n<p style=\"text-align: justify\"><strong> Tr\u1ebb em v\u00e0 thanh thi\u1ebfu ni\u00ean <\/strong><\/p>\n<p style=\"text-align: justify\">Trong khi h\u1ea7u h\u1ebft tr\u1ebb em kh\u1ecfe m\u1ea1nh \u1edf \u00dac v\u00e0 New Zealand nh\u1eadn \u0111\u1ee7 l\u01b0\u1ee3ng ti\u1ebfp x\u00fac \u00e1nh s\u00e1ng m\u1eb7t tr\u1eddi \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o m\u1ee9c \u0111\u1ed9 vitamin D \u0111\u1ea7y \u0111\u1ee7 th\u00ec m\u1ed9t s\u1ed1 l\u01b0\u1ee3ng tr\u1ebb \u1edf v\u00f9ng \u00f4n \u0111\u1edbi l\u1ea1i thi\u1ebfu h\u1ee5t vitamin D \u1edf m\u1ee9c \u0111\u1ed9 nh\u1eb9 trong su\u1ed1t m\u00f9a \u0111\u00f4ng. \u1ede Tasmania, 8% tr\u1ebb 8 tu\u1ed5i v\u00e0 68% tr\u1ebb 16 tu\u1ed5i c\u00f3 n\u1ed3ng \u0111\u1ed9 25-OHD trong huy\u1ebft thanh th\u1ea5p h\u01a1n 50 nmol\/L. So s\u00e1nh v\u1edbi s\u1ed1 li\u1ec7u \u1edf New Zealand th\u00ec ch\u1ec9 c\u00f3 50% to\u00e0n b\u1ed9 tr\u1ebb em \u1edf t\u1ea5t c\u1ea3 c\u00e1c nh\u00f3m tu\u1ed5i c\u00f3 n\u1ed3ng \u0111\u1ed9 25-OHD trong huy\u1ebft thanh th\u1ea5p h\u01a1n 50 nmol\/L. N\u1ebfu tr\u1ebb em c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c khuy\u1ebfn kh\u00edch tham gia c\u00e1c ho\u1ea1t \u0111\u1ed9ng ngo\u00e0i tr\u1eddi th\u01b0\u1eddng xuy\u00ean, vi\u1ec7c b\u1ed5 sung vitamin D cho tr\u1ebb em v\u00e0 thanh thi\u1ebfu ni\u00ean l\u00e0 kh\u00f4ng khuy\u1ebfn c\u00e1o. Tr\u1ebb em c\u00f3 m\u00e0u da t\u1ed1i, \u00edt ti\u1ebfp x\u00fac v\u1edbi \u00e1nh n\u1eafng m\u1eb7t tr\u1eddi, hay ng\u01b0\u1eddi \u0111ang trong t\u00ecnh tr\u1ea1ng m\u1eafc b\u1ec7nh ti\u1ec1m \u1ea9n n\u00ean b\u1ed5 sung m\u1ed9t l\u01b0\u1ee3ng 400 IU vitamin D h\u1eb1ng ng\u00e0y (v\u00ed d\u1ee5 u\u1ed1ng 1 vi\u00ean thu\u1ed1c ch\u1ee9a nhi\u1ec1u vitamin v\u00e0 kho\u00e1ng ch\u1ea5t) \u0111\u1ec3 ng\u0103n ng\u1eeba t\u00ecnh tr\u1ea1ng thi\u1ebfu h\u1ee5t vitamin D. Anh ch\u1ecb em ru\u1ed9t c\u1ee7a tr\u1ebb \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n b\u1ecb thi\u1ebfu h\u1ee5t vitamin D c\u0169ng n\u00ean \u0111\u01b0\u1ee3c ki\u1ec3m tra. S\u1ef1 gi\u00fap \u0111\u1ee1 c\u1ee7a c\u1ed9ng \u0111\u1ed3ng \u0111\u1ecba ph\u01b0\u01a1ng v\u00e0 c\u00e1c nh\u00f3m v\u0103n h\u00f3a \u0111\u00f3ng vai tr\u00f2 ch\u1ee7 y\u1ebfu trong vi\u1ec7c \u0111\u1ea3m b\u1ea3o vi\u1ec7c ph\u1ed5 bi\u1ebfn c\u00e1c chi\u1ebfn l\u01b0\u1ee3c ng\u0103n ng\u1eeba n\u00e0y.<\/p>\n<table border=\"1\" width=\"100%\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td valign=\"top\" width=\"100%\">\n<h2 id=\"bang-1-\u2013-nguyen-nhan-thieu-hut-vitamin-d-o-tre-em-va-thanh-thieu-nien\"><strong> B\u1ea3ng 1 \u2013 Nguy\u00ean nh\u00e2n thi\u1ebfu h\u1ee5t vitamin D \u1edf tr\u1ebb em v\u00e0 thanh thi\u1ebfu ni\u00ean <\/strong><\/h2>\n<ul style=\"margin-left: 40px\">\n<li><strong> Gi\u1ea3m h\u1ea5p thu hay t\u1ed5ng h\u1ee3p vitamin D3 <\/strong>\n<ul>\n<li>Con c\u1ee7a m\u1eb9 thi\u1ebfu h\u1ee5t vitamin D sinh ra, ph\u1ed5 bi\u1ebfn nh\u1ea5t l\u00e0 ng\u01b0\u1eddi m\u1eb9 c\u00f3 m\u00e0u da t\u1ed1i ho\u1eb7c th\u01b0\u1eddng che k\u00edn m\u1eb7t, hay ph\u1ee5 n\u1eef ch\u00e2u \u00c1 ng\u1ea1i ti\u1ebfp x\u00fac v\u1edbi \u00e1nh n\u1eafng m\u1eb7t tr\u1eddi.<\/li>\n<li>B\u00fa s\u1eefa m\u1eb9 k\u00e9o d\u00e0i.<\/li>\n<li>M\u00e0u da t\u1ed1i.<\/li>\n<li>Gi\u1ea3m ti\u1ebfp x\u00fac \u00e1nh n\u1eafng m\u1eb7t tr\u1eddi- \u0103n m\u1eb7c qu\u00e1 k\u00edn, m\u1eafc b\u1ec7nh m\u00e3n t\u00ednh hay do n\u1eb1m vi\u1ec7n, thi\u1ec3u n\u0103ng tr\u00ed tu\u1ec7 v\u00e0 s\u1eed d\u1ee5ng qu\u00e1 nhi\u1ec1u kem ch\u1ed1ng n\u1eafng.<\/li>\n<li>D\u00f9ng th\u1ef1c ph\u1ea9m ch\u1ee9a \u00edt vitamin D.<\/li>\n<\/ul>\n<\/li>\n<li>\u200b <strong> Ch\u1ee9c n\u0103ng \u0111\u01b0\u1eddng ru\u1ed9t b\u1ea5t th\u01b0\u1eddng ho\u1eb7c h\u1ea5p th\u1ee5 k\u00e9m <\/strong>\n<ul>\n<li>R\u1ed1i lo\u1ea1n \u0111\u01b0\u1eddng ru\u1ed9t non (v\u00ed d\u1ee5 b\u1ec7nh celiac).<\/li>\n<li>Suy tuy\u1ebfn t\u1ee5y (v\u00ed d\u1ee5 nh\u01b0 x\u01a1 nang).<\/li>\n<li>T\u1eaft m\u1eadt (v\u00ed d\u1ee5 \u0111\u01b0\u1eddng m\u1eadt h\u1eb9p).<\/li>\n<\/ul>\n<\/li>\n<li><strong> Gi\u1ea3m vi\u1ec7c t\u1ed5ng h\u1ee3p ho\u1eb7c t\u0103ng s\u1ef1 suy gi\u1ea3m n\u1ed3ng \u0111\u1ed9 25-OHD hay 1,25-(OH)2D <\/strong>\n<ul>\n<li>M\u1eafc b\u1ec7nh gan m\u00e3n t\u00ednh ho\u1eb7c b\u1ec7nh th\u1eadn.<\/li>\n<li>D\u00f9ng thu\u1ed1c: rifampicin, isoniazid (thu\u1ed1c \u0111i\u1ec1u tr\u1ecb lao), v\u00e0 thu\u1ed1c ch\u1ed1ng co gi\u1eadt.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"100%\">25-OHD = 25-hydroxyvitamin D or calcidiol. 1,25-(OH)2D = 1,25-dihydroxyvitamin D or calcitriol.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: justify\">\n<table border=\"1\" width=\"100%\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td valign=\"top\" width=\"100%\">\n<h2 id=\"\"><strong> B\u1ea3ng 2 \u2013 D\u1ea5u hi\u1ec7u thi\u1ebfu h\u1ee5t vitamin D \u1edf x\u01b0\u01a1ng (t\u1eeb th\u01b0\u1eddng g\u1eb7p \u0111\u1ebfn \u00edt ph\u1ed5 bi\u1ebfn) <a name=\"0_pgfId-1102160\"><\/a> <\/strong><\/h2>\n<ul>\n<li>S\u01b0ng c\u1ed5 tay v\u00e0 m\u1eaft c\u00e1 ch\u00e2n.<\/li>\n<li>Chu\u1ed7i h\u1ea1t s\u01b0\u1eddn (\u0111\u1ea7u x\u01b0\u01a1ng s\u01b0\u1eddn ph\u1ed3ng l\u00ean ch\u1ed7 kh\u1edbp s\u1ee5n s\u01b0\u1eddn).<\/li>\n<li>Kh\u1edbp g\u1ed1i v\u1eb9o trong, kh\u1edbp g\u1ed1i v\u1eb9o ngo\u00e0i hay bi\u1ebfn d\u1ea1ng xoay \u0111\u1ea7u g\u1ed1i.<\/li>\n<li>Tr\u00e1n d\u1ed3.<\/li>\n<li>\u0110au ch\u00e2n tay ho\u1eb7c g\u00e3y x\u01b0\u01a1ng.<\/li>\n<li>Ch\u1ee9ng nhuy\u1ec5n s\u1ecd (x\u01b0\u01a1ng s\u1ecd m\u1ec1m, th\u01b0\u1eddng \u0111\u01b0\u1ee3c th\u1ea5y khi kh\u00e1m \u0111\u01b0\u1eddng kh\u00e2u s\u1ecd \u1edf 3 th\u00e1ng tu\u1ed5i \u0111\u1ea7u).<\/li>\n<li>H\u1ea1 canxi m\u00e1u \u2013 co gi\u1eadt, co c\u1ee9ng kh\u1edbp x\u01b0\u01a1ng b\u00e0n tay b\u00e0n ch\u00e2n.<\/li>\n<li>B\u1ec7nh c\u01a1, tr\u00ec ho\u00e3n s\u1ef1 ph\u00e1t tri\u1ec3n d\u00e2y th\u1ea7n kinh v\u1eadn \u0111\u1ed9ng.<\/li>\n<li>Ch\u1eadm \u0111\u00f3ng th\u00f3p.<\/li>\n<li>M\u1ecdc r\u0103ng ch\u1eadm.<\/li>\n<li>Gi\u1ea3m s\u1ea3n men r\u0103ng.<\/li>\n<li>T\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd.<\/li>\n<li>U n\u00e2u trong c\u01b0\u1eddng c\u1eadn gi\u00e1p th\u1ee9 ph\u00e1t.<\/li>\n<\/ul>\n<p><strong> \u0110\u1eb7c \u0111i\u1ec3m h\u00ecnh \u1ea3nh <\/strong><\/p>\n<ul>\n<li>H\u00ecnh n\u00fat chai, khuy\u1ebft v\u00e0 nh\u1ecdn ,\u1edf h\u00e0nh x\u01b0\u01a1ng c\u1ee7a x\u01b0\u01a1ng tr\u1ee5, x\u01b0\u01a1ng quay v\u00e0 x\u01b0\u01a1ng s\u01b0\u1eddnC\u1ea5u tr\u00fac m\u00f4 \u1edf h\u00e0nh x\u01b0\u01a1ng k\u00e9m.<\/li>\n<li>Lo\u00e3ng x\u01b0\u01a1ng.<\/li>\n<li>G\u00e3y x\u01b0\u01a1ng.<\/li>\n<\/ul>\n<p>&nbsp;<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: justify\">\n<table border=\"1\" width=\"100%\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td colspan=\"6\" valign=\"top\" width=\"100%\">\n<h2 id=\"bang-3-\u2013-quan-ly-viec-thieu-hut-vitamin-d\"><strong> B\u1ea3ng 3 \u2013 Qu\u1ea3n l\u00fd vi\u1ec7c thi\u1ebfu h\u1ee5t vitamin D <\/strong><\/h2>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"9%\"><\/td>\n<td colspan=\"2\" valign=\"top\" width=\"41%\">\n<p align=\"center\"><strong> Gi\u1ea3m canxi huy\u1ebft* <\/strong><\/p>\n<\/td>\n<td colspan=\"2\" valign=\"top\" width=\"30%\">\n<p align=\"center\"><strong> Thi\u1ebfu h\u1ee5t vitamin D\u2020 <\/strong><\/p>\n<\/td>\n<td valign=\"top\" width=\"18%\"><\/td>\n<\/tr>\n<tr>\n<td width=\"9%\">\n<p align=\"center\"><strong> Tu\u1ed5i <\/strong><\/p>\n<\/td>\n<td width=\"19%\">\n<p align=\"center\"><strong> Co gi\u1eadt <\/strong><\/p>\n<\/td>\n<td width=\"22%\">\n<p align=\"center\"><strong> Kh\u00f4ng co gi\u1eadt <\/strong><\/p>\n<\/td>\n<td width=\"15%\">\n<p align=\"center\"><strong> Nghi\u00eam tr\u1ecdng <\/strong><\/p>\n<\/td>\n<td width=\"14%\">\n<p align=\"center\"><strong> Duy tr\u00ec <\/strong><\/p>\n<\/td>\n<td width=\"18%\">\n<p align=\"center\"><strong> S\u00e0ng l\u1ecdc <\/strong><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"9%\">\n<p style=\"text-align: center\" align=\"center\">&lt; 1<\/p>\n<p style=\"text-align: center\" align=\"center\">th\u00e1ng<\/p>\n<\/td>\n<td style=\"text-align: justify\" rowspan=\"3\" valign=\"top\" width=\"19%\">10% canxi gluconat: 0.5 mL\/kg (t\u1ed1i \u0111a 20 mL) ti\u00eam t\u0129nh m\u1ea1ch ch\u1eadm tr\u00ean 30\u201360 ph\u00fat.<\/td>\n<td style=\"text-align: justify\" rowspan=\"3\" valign=\"top\" width=\"22%\">Canxi: 40 &#8211; 80 mg\/kg\/ng\u00e0y<br \/>\n(1-2 mmol\/kg\/ng\u00e0y) u\u1ed1ng 4-6 li\u1ec1u, v\u00e0 Calcitriol: 50-100<br \/>\nng\/kg\/ng\u00e0y u\u1ed1ng.<br \/>\n2\u20133 li\u1ec1u cho \u0111\u1ebfn khi n\u1ed3ng \u0111\u1ed9 canxi trong huy\u1ebft thanh &gt;2.1 mmol\/L.<\/td>\n<td valign=\"top\" width=\"15%\">\n<p style=\"text-align: justify\">Vitamin D: 1000 IU (25 \u03bcg) h\u00e0ng ng\u00e0y trong 3 th\u00e1ng.<\/p>\n<p style=\"text-align: justify\">\n<\/td>\n<td style=\"text-align: justify\" rowspan=\"3\" valign=\"top\" width=\"14%\">Vitamin D: 400 IU (10 \u03bcg) h\u00e0ng ng\u00e0y ho\u1eb7c 150 000 IU (3750 \u03bcg) \u0111\u1ea7u m\u00f9a thu.<\/td>\n<td rowspan=\"3\" valign=\"top\" width=\"18%\">\n<p style=\"text-align: justify\"><strong> 1 th\u00e1ng: <\/strong> canxi huy\u1ebft thanh v\u00e0 phosphat ki\u1ec1m.<\/p>\n<p style=\"text-align: justify\"><strong> 3 th\u00e1ng: <\/strong> canxi huy\u1ebft thanh, magie, phosphat, phosphat ki\u1ec1m, calcidiol, hormon tuy\u1ebfn c\u1eadn gi\u00e1p. Ch\u1ee5p x-quang c\u1ed5 tay \u0111\u1ec3 xem x\u00e9t \u0111i\u1ec1u tr\u1ecb c\u00f2i x\u01b0\u01a1ng.<\/p>\n<p style=\"text-align: justify\"><strong> H\u00e0ng n\u0103m: <\/strong><br \/>\nCalcidiol.<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"9%\">\n<p align=\"center\">1\u201312<\/p>\n<p align=\"center\">th\u00e1ng<\/p>\n<\/td>\n<td style=\"text-align: justify\" valign=\"top\" width=\"15%\">Vitamin D: 3000 IU (75 \u03bcg) h\u00e0ng ng\u00e0y trong 3 th\u00e1ng, ho\u1eb7c 300 000 IU (7500 \u03bcg) trong 1-7<br \/>\nng\u00e0y.<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"9%\">\n<p align=\"center\">&gt; 12<\/p>\n<p align=\"center\">th\u00e1ng<\/p>\n<\/td>\n<td style=\"text-align: justify\" valign=\"top\" width=\"15%\">Vitamin D: 5000 IU (125 \u03bcg) h\u00e0ng ng\u00e0y trong 3 th\u00e1ng, ho\u1eb7c 500 000 IU (15 000 \u03bcg) trong 1-7<br \/>\nng\u00e0y.<\/td>\n<\/tr>\n<tr>\n<td colspan=\"6\" valign=\"top\" width=\"100%\">\n<p style=\"text-align: justify\">* M\u1ee5c \u0111\u00edch c\u1ee7a \u0111i\u1ec1u tr\u1ecb l\u00e0 \u0111\u1ec3 ng\u0103n ch\u1eb7n t\u00ecnh tr\u1ea1ng co gi\u1eadt, ch\u1ee9 kh\u00f4ng ph\u1ea3i \u0111\u1ec3 b\u00ecnh th\u01b0\u1eddng h\u00f3a canxi huy\u1ebft thanh. N\u1ebfu co gi\u1eadt k\u00e9o d\u00e0i, \u0111\u00f2i h\u1ecfi ph\u1ea3i truy\u1ec1n ho\u1eb7c ti\u00eam canxi l\u00ean \u0111\u1ebfn 4 mmol \/ kg \/ ng\u00e0y v\u00e0o t\u0129nh m\u1ea1ch th\u01b0\u1eddng xuy\u00ean \u0111\u1ec3 n\u1ed3ng \u0111\u1ed9 canxi huy\u1ebft b\u00ecnh th\u01b0\u1eddng. Canxi c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ti\u00eam v\u00e0o t\u0129nh m\u1ea1ch \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb h\u1ea1 canxi m\u00e1u kh\u00f4ng co gi\u1eadt. Nh\u01b0ng ph\u1ea3i xem x\u00e9t nguy c\u01a1 b\u1ecfng canxi v\u00e0 \u0111\u1ec3 l\u1ea1i s\u1eb9o. 1\u03b1-hydroxyvitamin D3 l\u00e0 m\u1ed9t gi\u1ea3i ph\u00e1p thay th\u1ebf cho calcitriol \u1edf m\u1ee9c 60-120 ng \/ kg \/ ng\u00e0y. Ergocalciferol (vitamin D2) hay cholecalciferol (vitamin D3). \u0110\u00e2y l\u00e0 li\u1ec7u ph\u00e1p d\u00f9ng vitamin D li\u1ec1u cao (\u0111i\u1ec1u tr\u1ecb stoss), t\u0103ng canxi m\u00e1u v\u00e0 ch\u1ee9ng nhi\u1ec5m canxi th\u1eadn \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o v\u1edbi c\u00e1c li\u1ec7u ph\u00e1p nh\u01b0 v\u1eady \u1edf tr\u1ebb em \u0111\u01b0\u1ee3c nu\u00f4i d\u01b0\u1ee1ng c\u1ea9n th\u1eadn.31<\/p>\n<p style=\"text-align: justify\">Calcitriol = 1,25-dihydroxyvitamin D. Calcidiol = 25-hydroxyvitamin D.<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: justify\">\n<table border=\"1\" width=\"100%\" cellspacing=\"0\" cellpadding=\"0\" align=\"left\">\n<tbody>\n<tr>\n<td colspan=\"2\" valign=\"top\" width=\"100%\">\n<h2 id=\"bang-4-\u2013-khuyen-nghi-ve-luong-canxi-hang-ngay-doi-voi-tre-em-khoe-manh\"><strong> B\u1ea3ng 4 \u2013 Khuy\u1ebfn ngh\u1ecb v\u1ec1 l\u01b0\u1ee3ng canxi h\u1eb1ng ng\u00e0y \u0111\u1ed1i v\u1edbi tr\u1ebb em kh\u1ecfe m\u1ea1nh <\/strong><\/h2>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"27%\">\n<p style=\"text-align: center\" align=\"center\"><strong> Tu\u1ed5i <\/strong><\/p>\n<\/td>\n<td style=\"text-align: center\" valign=\"top\" width=\"72%\">\n<p align=\"center\"><strong> L\u01b0\u1ee3ng canxi c\u1ea7n thi\u1ebft (mg\/ng\u00e0y) <\/strong><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"27%\">\n<p align=\"center\">0\u20136 th\u00e1ng<\/p>\n<\/td>\n<td valign=\"top\" width=\"72%\">\n<p align=\"center\">210<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"27%\">\n<p align=\"center\">6\u201312 th\u00e1ng<\/p>\n<\/td>\n<td valign=\"top\" width=\"72%\">\n<p align=\"center\">270<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"27%\">\n<p align=\"center\">1\u20133 tu\u1ed5i<\/p>\n<\/td>\n<td valign=\"top\" width=\"72%\">\n<p align=\"center\">500<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"27%\">\n<p align=\"center\">4\u20138 tu\u1ed5i<\/p>\n<\/td>\n<td valign=\"top\" width=\"72%\">\n<p align=\"center\">800<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center\" valign=\"top\" width=\"27%\">\n<p align=\"center\">9\u201318 tu\u1ed5i<\/p>\n<\/td>\n<td valign=\"top\" width=\"72%\">\n<p style=\"text-align: center\" align=\"center\">1300<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: justify\">\n<p style=\"text-align: justify\">\n<p style=\"text-align: justify\">\n<table border=\"1\" width=\"100%\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td valign=\"top\" width=\"100%\">\n<h2 id=\"\"><strong> B\u1ea3ng 5- Qu\u00e1 tr\u00ecnh th\u1ed1ng nh\u1ea5t <\/strong><\/h2>\n<p style=\"text-align: justify\">\u00dd ki\u1ebfn th\u1ed1ng nh\u1ea5t n\u00e0y \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n b\u1edfi m\u1ed9t nh\u00f3m l\u00e0m vi\u1ec7c bao g\u1ed3m th\u00e0nh vi\u00ean c\u1ee7a h\u1ed9i n\u1ed9i ti\u1ebft khoa nhi \u00dac, H\u1ed9i x\u01b0\u01a1ng khoa nhi \u00dac, b\u00e1c s\u0129 s\u1ee9c kh\u1ecfe cho b\u1ec7nh nhi di c\u01b0, b\u00e1c s\u0129 s\u1ea3n khoa, c\u00e1c chuy\u00ean gia y t\u1ebf c\u1ed9ng \u0111\u1ed3ng v\u00e0 th\u00e0nh vi\u00ean c\u1ee7a c\u00e1c nh\u00f3m l\u00e0m vi\u1ec7c ch\u1ecbu tr\u00e1ch nhi\u1ec7m trong vi\u1ec7c h\u01b0\u1edbng d\u1eabn ng\u01b0\u1eddi l\u1edbn v\u1ec1 s\u1ee9c kh\u1ecfe li\u00ean quan \u0111\u1ebfn vitamin D v\u00e0 x\u01b0\u01a1ng. T\u1ea5t c\u1ea3 t\u00e1c gi\u1ea3 \u0111\u00f3ng vai tr\u00f2 t\u00edch c\u1ef1c trong vi\u1ec7c ph\u00e1t tri\u1ec3n c\u00e1c b\u00e1o c\u00e1o v\u00e0 \u0111\u1ed3ng \u00fd v\u1edbi c\u00e1c khuy\u1ebfn c\u00e1o.<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2>T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n<p style=\"text-align: justify\"><a href=\"https:\/\/www.mja.com.au\/journal\/2006\/185\/5\/prevention-and-treatment-infant-and-childhood-vitamin-d-deficiency-australia-and\" target=\"_blank\" rel=\"noopener\"> https:\/\/www.mja.com.au\/journal\/2006\/185\/5\/prevention-and-treatment-infant-and-childhood-vitamin-d-deficiency-australia-and <\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Thi\u1ebfu h\u1ee5t vitamin D v\u00e0 b\u1ec7nh c\u00f2i x\u01b0\u01a1ng do thi\u1ebfu ch\u1ea5t dinh d\u01b0\u1ee1ng l\u00e0 v\u1ea5n \u0111\u1ec1 s\u1ee9c kh\u1ecfe nhi khoa ch\u00ednh t\u1ea1i \u00dac v\u00e0 New Zealand. Nguy\u00ean nh\u00e2n ch\u1ee7 y\u1ebfu l\u00e0 do gi\u1ea3m s\u1ef1 t\u1ed5ng h\u1ee3p vitamin D<\/p>\n","protected":false},"author":147,"featured_media":1526,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[6011,6012],"tags":[4179,4181,4182,4183,4180],"series":[1916],"coauthors":[],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.8 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Ng\u0103n ng\u1eeba v\u00e0 \u0111i\u1ec1u tr\u1ecb s\u1ef1 thi\u1ebfu h\u1ee5t vitamin D cho tr\u1ebb s\u01a1 sinh v\u00e0 tr\u1ebb nh\u1ecf \u1edf \u00dac v\u00e0 Newzealand: \u00fd ki\u1ebfn th\u1ed1ng nh\u1ea5t - Y H\u1ecdc C\u1ed9ng \u0110\u1ed3ng<\/title>\n<meta name=\"description\" content=\"Thi\u1ebfu h\u1ee5t vitamin D v\u00e0 b\u1ec7nh c\u00f2i x\u01b0\u01a1ng do thi\u1ebfu ch\u1ea5t dinh d\u01b0\u1ee1ng l\u00e0 v\u1ea5n \u0111\u1ec1 s\u1ee9c 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