2. Vitamins
13 vitamins are necessary for health of a child.
VitaminsA, D, E, and K are fat-soluble, and all others are
water-soluble
Fat-soluble vitamins are more readily stored in the body, but
they may be poorly absorbed in fat malabsorption disorders
A deficiency of vitamins may be primary (dietary in origin) or
secondary because of disturbances in intestinal absorption,
transport in the blood, tissue storage, or metabolic conversion.
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3. Vitamin A deficiency
Causes of Vit. A deficiency :
◦ Diet deficient in Vit A
◦ Decreased absorption due to chronic
intestinal disorders
◦ Reduced storage in the liver
◦ Increased requirement of Vit A
Deficiency
◦ Ocular and extraocular lesions
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4. Ocular leisons
◦ Night blindness- occurs due to the impairment of
dark adaptation. Earliest manifestations of vitamin A
deficiency is impaired vision, particularly in reduced
light
◦ Xerophthalmia- conjunctiva becomes dry, lusterless,
wrinkled with dirty brown color
◦ Bitots spot – triangular area at the temporal aspect
of the limbus covered by a white foamy substance
◦ Keratomalacia- softening, necrosis and ulceration2020/9/25 4Anju George , SGCON, PArumala
6. Extraocular lesions
◦ Follicular hyperkeratosis (toad skin/ phrynoderma) –
dry, scaly skin seen over the outer aspects of limbs
◦ Susceptibility to infections- increased susceptibility to
infections due to squamous metaplasia of epithelium.
Epithelium lining the upper respiratory passage and
urinary tract is replaced by keratinizing squamous cells
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7. Treatment
For xerophthalmia – Orally- Vit A, 2,00,000 IU stat
on the next day and 1-4 weeks later
◦ Half the dose is given to children between 6-12 months
◦ One quarter of the dose is given to children below 6 months
Acc to national programme for prevention of blindness,
children of 6-11 months should receive 1,00,000 IU of oral
vitamin A and children of 1-5 years should receive 2,00,000 IU
of vitamin A every 6 months in the target areas.
Encourage diet rich in Vit A
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8. Hypervitaminosis A
Children and adult ingesting >50,000 IU/day for several
month.
• Vitamin A in excess leads to:
• Nausea , vomiting
• Drowsiness
• Papilledema
• Symptoms of raised intracranial pressure
• In chronic cases children manifest with anorexia, failure to thrive,
alopecia, seborrhic dermatitis, hepatomegaly and tender bone
swelling
• Sclerae may be yellow orange in color which is reversible
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9. Thiamine – Vitamin B1
deficiency
Deficiency due to diet of polished rice
Deficiency – beriberi
◦ Two types of beriberi – wet and dry beriberi
Dry beriberi affects the nervous system
Clinical features – irritability, fatigue, emotional disturbances,
polyneuritis, headache, calf muscle tenderness, sluggish
tendon reflexes, difficulty in standing from sitting position,
reduced appetite , indigestion, slow growth and constipation.
Wet beriberi - - the main clinical features are palpitation,
tachycardia, dyspnea and edema
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10. Infantile beriberi – is classified into 3 types
◦ Cardiovascular type – characterized by tachycardia, dyspnea,
cyanosis, vomiting, shrill cry
◦ Aphonic type - characterized by hoarse cry followed by
aphonia. Terminal manifestations are dysnea, puffiness and
pitting edema
◦ Neurologic type characterized by vomiting, tremors,
convulsions, ptosis, nystagmus, and extraocular muscular
paralysis
Treatment of Beriberi
◦ Thiamine 10 mg IV on diagnosis for the next 5 days
◦ Oral thiamine 10 mg for 2 times followed by 10 mg oral daily
once for the next 6 weeks
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11. Riboflavin – Vitamin B2
deficiency
Deficiency is rare and often occurs with other B
vitamin deficiencies. It produces symptoms confined
to skin and mucosa.
Several months for symptoms to occur
Burning, watering and itching of eyes
Photophobia
Keratitis
Cheilosis
Glossitis
Treatment
◦ Riboflavin 3-10mg orally or 2 mg IM daily for one week
followed by 10 mg orally for 3 weeks
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12. Niacin - Vitamin B3 deficiency
Cause - Processing of grains removes most of their
niacin content so flour is enriched with the vitamin
Deficiency – Pellagra which is characterized by ‘Three
Ds’: diarrhea, dermatitis and dementia. Other
neurological and gastrointestinal manifestations are
anorexia, nausea, vomiting , achlorhydria, muscle
weakness and loss of memory.
Treatment
◦ Oral nicotinamide 50-300mg per day for 2 weeks
◦ Diet rich in B-complex
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13. Pyridoxine – B6 deficiency
Deficiency is rare
Deficiency is due to inborn errors of metabolism or
secondary to other disorders like prolonged use of anti
–TB drug such as isoniazid. To prevent it Tab.
Pyridoxine is usually administered with isoniazid
Clinical features
◦ Nausea, vomiting , diarrhea, hyperacusis, convulsions,
irritability, anemia, failure to thrive.
Treatment
◦ Pyridoxine 5 mg IM followed by 0.5 mg daily (oral) for 2
weeks.
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14. Folic acid deficiency
Cause is inadequate intake of folic acid rich
diet.
Deficiency – megaloblastic anemia, glossitis,
cheilosis, diarrhea, abdominal distension,
flatulence.
◦ Severe deficiency – leads to infertility and
sterility.
Treatment
◦ Folic acid supplements2020/9/25 14Anju George , SGCON, PArumala
15. Cyanocobalamin – vitamin B12
deficiency
Mostly seen in strict vegetarians, in patients who
have achlorhydria or who have undergone
gastrectomy, due to the absence of intrinsic factors,
Vit B12 is not absorbed which leads to
megaloblastic anemia (Pernicious anemia)
Treatment – administration of vitamin B12
parenterally for patients with achlorhydria and
patients who have undergone total gastrectomy.
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16. Ascorbic acid -Vitamin C Deficiency
Deficiency leads to Scurvy
Signs and symptoms are :
Bleeding gums
Subcutaneous bruising
Generalized tenderness along the shaft of lower limbs
Bleeding into the skin or joints, hematuria, malena, subdural
hemorrhages
Anemia
Weakness
Delayed wound healing
Subperiosteal hemorrhages
Presence of rosary at costochondral junction
Treatment – loading dose of Vitamin C 500 mg oral or
parenteral, followed by daily dose of 100-300 mg for
several weeks
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17. Vitamin D deficiency
Deficiency is Rickets
Signs and symptoms are :
◦ Reduced calcification of growing bones leads to growth failure and
bone deformity.
◦ Hypocalcaemia leads to muscular hypotonia , tetany and
convulsions
◦ Serum Alkaline phosphatase increased
◦ Protruberant abdomen
◦ Milestones delayed
◦ Disordered eruption of temporary teeth
◦ Craniotabes
◦ Fontanel is wider and closes late
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18. Bony deformities include :
◦ Curved legs(bow legs or knock knees)
◦ Deformed pelvis
◦ Pigeon chest (sternum is pushed forward )
◦ Harrisons groove – a horizontal depression corresponding to
costal insertion of the diaphragm
◦ Rachitic rosary – palpable enlargement of costochondral junctions
◦ Widening of wrists
◦ Kyphoscoliosis
Diagnosis – radiological and biochemical measurements
Treatment –
◦ Expose child to sunshine
◦ Vitamin D supplement intake per oral
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20. Calcium
Hypocalcemia is more common among
LBW babies, babies with PEM, artificially
fed babies, infants of diabetic mother
Clinical features – tetany and convulsion
Treatment – calcium 100-200 mg/kg/day
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21. Sodium
Cause – excessive sweating , diuretic
therapy , diarrhea and water intoxication
Clinical features – hypotension,
dehydration, shock, lethargy, seizures.
Treatment –
◦ Addition of salt in diet
◦ IV Administration of normal saline
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22. Iron
Deficiency – anemia
Cause – increased demand, decreased
intake, decreased intake , worm infestations,
blood loss and malabsorption. LBW babies
are more prone to Iron deficiency anemia
Treatment –
◦ Iron supplements
◦ Correcting underlying pathology
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23. Trace elements – iodine
Deficiency causes simple goiter,
hypothyroidism, still birth, CNS defects
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