This document discusses vitamin A deficiency, its signs, diagnosis, and treatment. It describes a case of a 10-year-old girl who presents with inability to see after darkness for two months and is diagnosed with protein-calorie malnutrition, anemia, and vitamin A deficiency based on her pale appearance and low weight. The document outlines the functions of vitamin A, signs of deficiency including eye and skin issues, and recommends treating deficiency by giving vitamin A supplements to children with symptoms or signs of deficiency.

1. Vitamin A deficiency
Prof. Imran Iqbal
Fellowship in Pediatric Neurology (Australia)
Prof of Paediatrics (2003-2018)
Prof of Pediatrics Emeritus, CHICH
Prof of Pediatrics, CIMS
Multan, Pakistan

4. Case scenario

5. What is your diagnosis?
• A ten year old girl child presents with inability to see after
darkness for the last two months. She has five sibs. Her
father is uneducated and does not have a regular job.
On examination, child is quite pale. Her weight is 22 kg.
• What is your diagnosis ?

6. Diagnosis
• A ten year old girl child presents with inability to see after
darkness for the last two months. She has five sibs. Her
father is uneducated and does not have a regular job.
On examination, child is quite pale. Her weight is 22 kg.
• What is your diagnosis ?
• Protein – Calorie malnutrition
• Nutritional Anemia
• Vitamin A deficiency

7. Vitamin A Deficiency Disorders

8. Vitamin A Deficiency Disorders

9. Beta – carotene and Vitamin A

10. Functions of Vitamin A

11. Vitamin A in Tissues

12. Vitamin A in Cells

13. Subclinical and Clinical Vitamin A deficiency

14. Clinical Features of Vitamin A deficiency
• Eyes
Night blindness
Dry conjunctiva – Bitot spots
Dry cornea – Ulceration, Haziness and Opacities
Keratomalacia – softening and perforation of cornea
• Low immunity – Infections
• Dry mucus membranes – Infections (bronchitis, diarrhea)
• Dry skin, keratosis
• Impaired repair of tissues (prolonged diarrhea, slow
wound healing

15. Progression of Eye Signs

16. Conjunctival Xerosis (dryness)

17. Bitot spots

18. Corneal opacity / scar

19. Diagnosis of Vitamin A deficiency
• Clinical Diagnosis (most important)
• Symptoms – night blindness, diarrhea
• Signs – eyes, skin
• Serum retinol levels (rarely needed) =
Normal = 20 – 80 ug/dl = 0.7 – 2.8 umol/l
• Vitamin A Deficiency < 0.35 umol/l

20. Epidemiology of
Vitamin A deficiency

21. Vitamin A deficiency in Pakistan
Pakistan National Nutrition Survey – 2018
• Vitamin A deficiency in children < 5 years = 51.5 %
• Severe Vitamin A deficiency = 12.1 %
• Vitamin A deficiency in women = 27.3 %
• Severe Vitamin A deficiency in women = 4.9 %

22. Causes of
Vitamin A deficiency

23. Vitamin A deficiency – from Mother to Child
• Low stores at birth
• Malnutrition
• Diet deficient in Vit A – prolonged animal milk feeds
– delayed weaning
• Infections – Measles
• Diarrhea and malabsorption

24. Body Requirements for Vitamin A
• Daily Requirement =
• Vitamin A = 400 – 600 ug/d = 1500 – 2500 IU/d
• 1ug RE (Retinol Equivalents) = 3.3 IU
• Fat – soluble vitamin
• Stored in liver for long time providing daily needs
• Mega (large) doses can be given every six months

25. Sources of Vitamin A
• Food sources
• Animal Sources – Fortified Milk, eggs, liver, fish
• Vegetable Sources - Mango, carrots, papaya
• B-carotene - Green vegetables
• Pharmaceutical sources
• Vitamin A drops / capsules
(one drop daily)
• Multi-vitamins

26. Complications of
Vitamin A deficiency

27. Vitamin A deficiency causes more Respiratory infections
• In Mild deficiency = 15 % have a respiratory infection
• In Severe deficiency = 65 % have a respiratory infection

28. Vitamin A deficiency increases Deaths
• In Normal child = Mortality 5 / 1000
• In Mild deficiency = Mortality 15 / 1000 (3 times)
• In Severe deficiency = Mortality 45 / 1000 (9 times)

29. Giving Vitamin A decreases Mortality

30. Vitamin A deficiency and Child Mortality
• Vitamin A deficiency increases proportion of
deaths caused by common infections in children
• Giving Vitamin A to children decreases their
their mortality

31. Conclusion
Giving
Vitamin A
to children
decreases
mortality

32. Vitamin A decreases deaths due to
Measles by 50 %

33. Measles
• maculopapular dark red rash
and one of the following:
• Runny nose
• Red eyes
• Cough

34. How to treat a child with Measles?

35. Give Vitamin A (3 mega doses) to every child with Measles

36. How to treat a child with
Vitamin A deficiency ?

37. Vitamin A
• Vitamin A should be given to every child with:
• Eye signs of Vitamin A deficiency (3 doses)
• Measles (3 doses)
• Acute Malnutrition (1 dose)
• Persistent diarrhea (1 dose)

38. Give Vitamin A (3 mega doses) to every child
with signs of Vitamin A deficiency

39. Toxicity of Vitamin A
• Frequent high doses of Vitamin A can result in toxicity
• Vitamin A toxicity can cause raised intracranial pressure
• Headache, vomiting, insomnia, altered mental status
• Osteoporosis can also occur

40. How to prevent Vitamin A
deficiency in children ?

41. One Vitamin A mega dose every six months

42. Protect every child by giving Vitamin A