VITAMIN A DEFICIENCY

Presentation
Mild forms of vitamin A deficiency may cause
no symptoms.
However, there may still be an increased risk
of developing respiratory infections
and gastroenteritis, and delayed growth and
bone development.
Fatigue may present as a consequence of
vitamin A deficiency anaemia
Presentation
Eye and vision:
night blindness
Keratomalacia
Conjunctival dryness, corneal
dryness, xerophthalmia.
Bitot's spots
Corneal perforation.
Blindness due to structural damage to the
retina
Presentation
Skin and hair:
Dry skin, dry hair, pruritus.
Broken fingernails.
Follicular hyperkeratosis secondary to blockage of hair
follicles, with plugs of keratin.
Other less specific changes include:
Keratinisation of mucous membranes.
Increased susceptibility to infection (due to impairment of
the humoral and cell-mediated immunity).
Skin changes (follicular hyperkeratosis) are also
common.
Investigations
Serum retinol study is costly.
Serum retinol-binding protein study is easier to perform and less
expensive.
Zinc level (zinc deficiency interferes with production of
retinol-binding protein).
Iron studies (iron deficiency can affect the metabolism of
vitamin A).
Renal function tests, electrolytes : to evaluate for
nutritional and hydration status.
In children
X-rays of the long bones : to evaluate bone growth and for
excessive deposition of periosteal bone.
Dark-adaptation threshold should be tested
Management
Treatment for subclinical vitamin A deficiency
the consumption of vitamin A-rich foods liver, beef,
chicken, eggs, fortified milk, carrots, mangoes, sweet
potatoes and leafy green vegetables.
Good animal sources of vitamin A :liver, egg yolks,
whole milk, animal butter and whole small fish (with
liver intact).
Animal sources, including vitamin A in breast milk, are
more bioavailable than vegetable sources, which
include carrots and other orange/yellow fruits and
vegetables, and dark green leafy vegetables.
Drugs
For clinically evident vitamin A deficiency,
treatment includes daily oral vitamin A
supplements
Children aged 3 years or younger - 600 micrograms
Children aged 4-8 years - 900 micrograms
Children aged 9-13 years - 1,700 micrograms
Children aged 14-18 years - 2,800 micrograms
All adults - 3,000 micrograms
Therapeutic doses for severe disease include 60,000
micrograms
Iron deficiency anemia
Symptoms
Most of the time, symptoms are mild at first and develop
slowly. Symptoms may include:
Feeling grumpy
Feeling weak or tired more often than usual, or with exercise
Headaches
Problems concentrating or thinking
As the anemia gets worse, symptoms may include:
Blue color to the whites of the eyes
Brittle nails
Light-headedness when you stand up
Pale skin color
Shortness of breath
Sore tongue
Exams and Tests
Blood tests:
Hematocrit and hemoglobin (red blood cell measures)
RBC indices
Tests to check iron levels
Bone marrow exam (rare)
Iron binding capacity (TIBC) in the blood
Serum ferritin
Serum iron level
Tests that may be done to look for the cause of iron
deficiency:
Colonoscopy
Fecal occult blood test
Upper endoscopy
Treatment
Taking iron supplements and eating iron-rich foods
are important parts of treating iron deficiency
anemia.
Iron supplements (most often ferrous sulfate)
Iron-rich foods include:
Chicken and turkey
Dried lentils, peas, and beans
Fish
Meats (liver is the highest source)
Peanut butter
Soybeans
Whole-grain bread


Malnutrition
Symptoms
Symptoms of malnutrition in children can
include:
failure to grow at the expected rate, both in terms
of weight and height (known as "failure to thrive")
changes in behaviour such as appearing unusually
irritable, sluggish or anxious
changes in hair and skin colour

Diagnosing malnutrition
Diagnosing malnutrition in children involves
taking a measurement of their weight and
height and then comparing it against what
would be the expected average height and
weight for a child of that age.
Some children will be below average as they
are naturally smaller, but a significant drop
below the expected level for an individual
could indicate a risk of malnutrition.
Blood tests can also be used to measure levels
of protein in the blood. Low levels of protein
may suggest that a child is malnourished

Diagnosing malnutrition
Treatment
hospital treatment is often required.
Childhood malnutrition can sometimes be treated
by giving child additional nutrients to increase
their intake of energy and protein. \
This may involve taking special supplements and
eating foods high in energy and nutrients.
The underlying cause of their malnutrition may
also need to be treated.

Treatment
Severely malnourished children need to be fed
and rehydrated with great care and so cannot
be given a normal diet straight away.
Once their condition stabilises, they can
gradually be introduced to a normal diet.
Malnutrition due to lack of food is a child
protection issue so police and social services
need to be informed.

Kwashiorkor
Symptoms
Changes in skin pigment
Decreased muscle mass
Diarrhea
Failure to gain weight and
grow
Fatigue
Hair changes (change in color
or texture)



Increased and more severe
infections due to damaged
immune system
Irritability
Large belly that sticks out
(protrudes)
Lethargy or apathy
Loss of muscle mass
Rash (dermatitis)
Shock (late stage)
Swelling (edema)
Signs and tests
The physical examination may show an enlarged
liver (hepatomegaly) and general swelling.
Tests may include:
Arterial blood gas
Complete blood count (CBC)
Creatinine clearance
Serum creatinine
Serum potassium
Total protein levels
Urinalysis

Treatment
Getting more calories and protein
Treatment depends on the severity of the
condition. People who are in shock need
immediate treatment to restore blood volume
and maintain blood pressure.
Calories are given first in the form
of carbohydrates, simple sugars, and fats.
Proteins are started after other sources of
calories have already provided energy. Vitamin
and mineral supplements are essential.
Treatment
Since the person will have been without much
food for a long period of time , Food must be
reintroduced slowly. Carbohydrates are given first
to supply energy, followed by protein foods.
Many malnourished children will develop
intolerance to milk sugar (lactose intolerance).
They will need to be given supplements with
the enzyme lactase so that they can tolerate milk
products