Vitamin E deficiency

1. Vitamin E (alpha-tocopherol)
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

2. Al-Quran sura AlRahman 55:8-13

3. Clinical Scenario

4. Child with prolonged jaundice
• A 3 year old child presented with falling tendency for the last
three months. Previously child had normal neurological
development
• Mother says that child is having yellow eyes and pale stools since
first month of age
• On examination, child has jaundice. Liver is palpable by 3 cm
below the costal margin.
• Neurological examination shows ataxia, which is increased by
closing the eyes (positive Romberg sign) and absent deep tendon
reflexes.
• Diagnosis is Chronic Liver Disease and Vitamin E deficiency due to
fat malabsorption
• Child improves on starting daily doses of Vitamin E

5. Functions of Vitamin E (alpha-tocopherol)
• Maintains integrity of Cell Membranes
• Needed for myelination of nerves and nerve
impulse conduction
• Prevents damage from free radicals
• Anti-oxidant activity

6. Clinical Features of Vitamin E deficiency
• Hemolytic Anemia in premature infants
• Neuropathy and Ataxia in children and adults

7. Diagnosis
• Clinical presentation
• Serum Vitamin E level

8. Etiology of Vitamin E deficiency
• Sources of Vitamin E – vegetable oils, nuts
• Daily Requirement = 7 - 15 mg / day
• Vitamin E is a fat soluble vitamin
• Vitamin E deficiency develops in the presence of
Fat malabsorption

9. Epidemiology of Vitamin E deficiency
• Vitamin E is stored in body and its deficiency is rare.
Vitamin E deficiency can develop in:
• Premature infants receiving unfortified milk
• Chronic Liver Disease with cholestasis
• Fat malabsorption

10. Treatment of Vitamin E deficiency
• Daily dose of Vitamin E is given
• DOSE : 25 – 50 mg / day
• In Chronic Liver Disease and Fat Malabsorption
states, daily dose of Vitamin E is needed

11. Prevention of Vitamin E deficiency
• Adequate Vitamin E intake by mothers
• Fortified milk formula
• Adequate fat intake for infants and children
• Multiple micronutrient sachet from 6 months to 5
years of age