Vitamin A

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Vitamin A

  1. 1. VITAMIN A DR KAUSIK SUR D.C.H,DNB ASSISTANT PROFESSOR DEPARTMENT OF PEDIATRICS VIVEKANANDA INSTITUTE OF MEDICAL SCIENCES RAMAKRISHNA MISSION SEVA PRATISTHAN KOLKATA,INDIA
  2. 2. SOURCES <ul><li>ANIMAL FOODS </li></ul><ul><li>Liver </li></ul><ul><li>Egg </li></ul><ul><li>Butter </li></ul><ul><li>Cheese </li></ul><ul><li>Whole milk </li></ul><ul><li>Fish </li></ul><ul><li>Meat </li></ul><ul><li>PLANT FOODS </li></ul><ul><li>Spinach </li></ul><ul><li>Cabbage </li></ul><ul><li>Lettuce </li></ul><ul><li>Curry </li></ul><ul><li>Reddish leaves </li></ul><ul><li>Yellow pumpkin </li></ul><ul><li>Mangos </li></ul><ul><li>Papaya </li></ul><ul><li>Tomatos </li></ul>
  3. 6. <ul><li>Most of the retinol is esterified with saturated fatty acids incorporated into lymph chylomicron enter bloodsteram converted to chylomicron remnants taken up by liver together with their content of retionol </li></ul>
  4. 7. THIS REACTION IS ACCOMPANIED BY A CONFORMATIONAL CHANGE THAT INDUCES CHANGE IN PERMEABILITY OF CATIONS, INCRSED POLARIZATION OF MEMBRANES AND TRIGGERING OF A NERVE IMPULSE
  5. 8. RETINOIC ACID PARTICIPATES IN GLYCOPROTEIN SYNTHESIS <ul><li>Retinoic acid participates in promotion of growth and differentiation of tissues </li></ul><ul><li>Retinoyl phosphate functions as a carrier of oligosaccharides across the lipid bilayer of cell </li></ul>
  6. 9. VITAMIN A IS ESSENTIAL FOR <ul><li>Normal maintenance and function of body tissues </li></ul><ul><li>Vision </li></ul><ul><li>Cellular integrity </li></ul><ul><li>Immune competence </li></ul><ul><li>Growth </li></ul>
  7. 10. <ul><li>BETA CAROTENE – </li></ul><ul><li>Antioxidant property </li></ul><ul><li>Scavenger of free radicles </li></ul><ul><li>Vitamin a and beta carotene may reduce the incidence of lung, breast, oral, esophageal, bladder cancer </li></ul>
  8. 11. RECOMMENDED DAILY INTAKE <ul><li>INFANTS 350 µg </li></ul><ul><li>1-6 YEARS 400 µg </li></ul><ul><li>7-12 YEARS 600 µg </li></ul>
  9. 12. DIAGNOSIS OF VIT A DEFICIENCY <ul><li>Assessment of dietary vit.A </li></ul><ul><li>Eye examination </li></ul><ul><li>SERUM RETINOL level(normal level is 28 to 86 μg/dl (1 to 3 µmol/L) not an acurrate indicator unless the deficiency is severe and liver stores depleted </li></ul><ul><li>ROSE BENGAL STAIN TEST(RBST) for early conjunctival xerosis </li></ul><ul><li>CONJUNCTIVAL IMPRESSION CYTOLOGY(CIC) for preclinical VAD </li></ul><ul><li>Night vision threshold test </li></ul>
  10. 13. WHO CLASSIFICATION OF XEROPTHALMIA <ul><li>CIassification of xerophthalmia World Health Organization, 1976) </li></ul><ul><li>XS Night blindness </li></ul><ul><li>XI A Conjunctival xerosis </li></ul><ul><li>XIB Bitot’s spot </li></ul><ul><li>X2 Corneal xerosis </li></ul><ul><li>X3A Corneal ulceration-keratomalacia > 1/3 corneal surface </li></ul><ul><li>X3B Corneal ulceration- keratomalacia < 1/3 corneal surface </li></ul><ul><li>XS Corneal scar </li></ul><ul><li>XF Xerophthalmic fundus </li></ul>
  11. 15. <ul><li>Conjuctiva becomes dry- CONJUNCTIVAL XEROSIS </li></ul><ul><li>Conjunctive keratinizes and develops plaques- BITITS SPOT </li></ul>
  12. 18. <ul><li>Cornea keratinizes, becomes opaque, is susceptible to infection and forms dry, scaly layer of cells </li></ul><ul><li>Infection occurs, lymphocytes infiltrates and the cornea becomes wrinkled </li></ul><ul><li>Degenerates irreversibly (KERATOMALACIA) </li></ul>
  13. 22. OTHER FEATURES OF VITAMIN A DEFICIENCY <ul><li>SKIN CHANGES- Scaly, toad like (phrynoderma) </li></ul><ul><li>Squamous metaplasia of respiratory mucosa more prone to RESPIRATORY INFECTIONS </li></ul><ul><li>Alteration in mucosa of renal pelvis and UB formation of RENAL AND VESICAL CALCULI </li></ul><ul><li>Atrophy of germinal epithelium may interfere with REPRIDUCTIVE FN </li></ul>
  14. 23. <ul><li>DIARRHEA </li></ul><ul><li>ANEMIA </li></ul><ul><li>APATHY </li></ul><ul><li>MR </li></ul><ul><li>INCREASED INTRACRANIAL PRESSURE </li></ul>
  15. 24. TREATMENT OF VITAMIN A DEFICIENCY <ul><li>SPECIFIC- </li></ul><ul><li>ORAL VIT.A 50,000 IU (<6 months) </li></ul><ul><li>1 LAKH IU (6-12 months) </li></ul><ul><li>2 LAKH IU (> 1 year) </li></ul><ul><li>SAME DOSE NEXT DAY </li></ul><ul><li>SAME DOSE 4 WEEKS LATER </li></ul>
  16. 25. <ul><li>PARENTERAL WATER SOLUBLE VIT. A </li></ul><ul><li>DOSE- 3/4 th DOSE <6 months </li></ul><ul><li>½ DOSE 6-12 months </li></ul><ul><li>INDICATION- </li></ul><ul><li>Impaired oral intake </li></ul><ul><li>Persistent vomiting </li></ul><ul><li>Severe malabsorption </li></ul>
  17. 26. <ul><li>LOCAL TREATMENT </li></ul><ul><li>CORNEAL ULCER- </li></ul><ul><li>ANTIBIOTICS DROPS/OINT . THRICE DAILY </li></ul><ul><li>(to prev. sec. infection) </li></ul><ul><li>PADDING OF EYE (to prevent dehydration and furthur corneal exposure) </li></ul><ul><li>MYDRIATIC- ATROPINE DROP 1% OR OINT. ONCE DAILY </li></ul>
  18. 27. PREVENTION <ul><li>NOT BREAST FED INFANTS- </li></ul><ul><li>50,000 IU BY 2 MONTHS AGE </li></ul><ul><li>( OR 2 DOSES OF 25000 IU AT I MOMTH INTERVAL) </li></ul><ul><li>EVERY INFANT- </li></ul><ul><li>ONE DOSE OF 1 LAKH IU VIT A ALONG WITH MEASLES VACCINE AT 9 MONTHS </li></ul><ul><li>4 MORE DOSES OF 2 LAKH IU EACH AT </li></ul><ul><li>18,24,30,36 MONTHS </li></ul>
  19. 28. <ul><li>IN VIT.A ENDEMIC AREAS </li></ul><ul><li>CHILD SUFFERING FROM </li></ul><ul><li>MEASLEA </li></ul><ul><li>SEVERE PEM </li></ul><ul><li>2 DOSES OF ORAL VIT.A ON 2 CONSECUTIVE DAYS </li></ul><ul><li>(1 LAKH FOR <1 YEAR AND 2 LAHS >1 YEAR) </li></ul>
  20. 29. <ul><li>PERSISTENT DIARRHEA, OTHER PROLONGED FRBRILE CONDITION </li></ul><ul><li>One dose in each episode with 1 month interval </li></ul>
  21. 30. <ul><li>CONSUMPTION OF FOODS RICH IN VIT A </li></ul><ul><li>LONG TERM PREVENTION STRATEGIES </li></ul><ul><li>Nutrition education and dietary diversification </li></ul><ul><li>HORTICULTURAL INTERVENTION incl. Home gardening </li></ul><ul><li>Nutritional supplementation </li></ul><ul><li>Selective fortification for high risk and special groups </li></ul>
  22. 31. <ul><li>All Infants with birth weight of ≤1 kg should receive 5000IU of Vitamin A i.m 3 times a week for first 4 weeks- slightly reduce the incidence of chronic lung disease </li></ul><ul><li>Manual of neonatal care – john p cloharty, 6 th ed </li></ul>

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