Vitamin A is essential for normal body functions like vision, cellular integrity, immune function and growth. It is found naturally in animal foods like liver, egg yolks, and dairy products as well as plant foods like spinach, carrots and mangoes. Vitamin A deficiency can cause night blindness and dryness of the eyes and later corneal ulceration and blindness if left untreated. Early signs are diagnosed through eye examinations and blood tests while more advanced cases show skin and respiratory issues. Deficiency is treated with high oral or injectable vitamin A supplements depending on severity. Prevention involves breastfeeding, vitamin A supplements with vaccines and adequate nutrition.

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. SOURCES ANIMAL FOODS Liver Egg Butter Cheese Whole milk Fish Meat PLANT FOODS Spinach Cabbage Lettuce Curry Reddish leaves Yellow pumpkin Mangos Papaya Tomatos

6. 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

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

8. RETINOIC ACID PARTICIPATES IN GLYCOPROTEIN SYNTHESIS Retinoic acid participates in promotion of growth and differentiation of tissues Retinoyl phosphate functions as a carrier of oligosaccharides across the lipid bilayer of cell

9. VITAMIN A IS ESSENTIAL FOR Normal maintenance and function of body tissues Vision Cellular integrity Immune competence Growth

10. BETA CAROTENE – Antioxidant property Scavenger of free radicles Vitamin a and beta carotene may reduce the incidence of lung, breast, oral, esophageal, bladder cancer

11. RECOMMENDED DAILY INTAKE INFANTS 350 µg 1-6 YEARS 400 µg 7-12 YEARS 600 µg

12. DIAGNOSIS OF VIT A DEFICIENCY Assessment of dietary vit.A Eye examination 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 ROSE BENGAL STAIN TEST(RBST) for early conjunctival xerosis CONJUNCTIVAL IMPRESSION CYTOLOGY(CIC) for preclinical VAD Night vision threshold test

13. WHO CLASSIFICATION OF XEROPTHALMIA CIassification of xerophthalmia World Health Organization, 1976) XS Night blindness XI A Conjunctival xerosis XIB Bitot’s spot X2 Corneal xerosis X3A Corneal ulceration-keratomalacia > 1/3 corneal surface X3B Corneal ulceration- keratomalacia < 1/3 corneal surface XS Corneal scar XF Xerophthalmic fundus

15. Conjuctiva becomes dry- CONJUNCTIVAL XEROSIS Conjunctive keratinizes and develops plaques- BITITS SPOT

18. Cornea keratinizes, becomes opaque, is susceptible to infection and forms dry, scaly layer of cells Infection occurs, lymphocytes infiltrates and the cornea becomes wrinkled Degenerates irreversibly (KERATOMALACIA)

22. OTHER FEATURES OF VITAMIN A DEFICIENCY SKIN CHANGES- Scaly, toad like (phrynoderma) Squamous metaplasia of respiratory mucosa more prone to RESPIRATORY INFECTIONS Alteration in mucosa of renal pelvis and UB formation of RENAL AND VESICAL CALCULI Atrophy of germinal epithelium may interfere with REPRIDUCTIVE FN

23. DIARRHEA ANEMIA APATHY MR INCREASED INTRACRANIAL PRESSURE

24. TREATMENT OF VITAMIN A DEFICIENCY SPECIFIC- ORAL VIT.A 50,000 IU (<6 months) 1 LAKH IU (6-12 months) 2 LAKH IU (> 1 year) SAME DOSE NEXT DAY SAME DOSE 4 WEEKS LATER

25. PARENTERAL WATER SOLUBLE VIT. A DOSE- 3/4 th DOSE <6 months ½ DOSE 6-12 months INDICATION- Impaired oral intake Persistent vomiting Severe malabsorption

26. LOCAL TREATMENT CORNEAL ULCER- ANTIBIOTICS DROPS/OINT . THRICE DAILY (to prev. sec. infection) PADDING OF EYE (to prevent dehydration and furthur corneal exposure) MYDRIATIC- ATROPINE DROP 1% OR OINT. ONCE DAILY

27. PREVENTION NOT BREAST FED INFANTS- 50,000 IU BY 2 MONTHS AGE ( OR 2 DOSES OF 25000 IU AT I MOMTH INTERVAL) EVERY INFANT- ONE DOSE OF 1 LAKH IU VIT A ALONG WITH MEASLES VACCINE AT 9 MONTHS 4 MORE DOSES OF 2 LAKH IU EACH AT 18,24,30,36 MONTHS

28. IN VIT.A ENDEMIC AREAS CHILD SUFFERING FROM MEASLEA SEVERE PEM 2 DOSES OF ORAL VIT.A ON 2 CONSECUTIVE DAYS (1 LAKH FOR <1 YEAR AND 2 LAHS >1 YEAR)

29. PERSISTENT DIARRHEA, OTHER PROLONGED FRBRILE CONDITION One dose in each episode with 1 month interval

30. CONSUMPTION OF FOODS RICH IN VIT A LONG TERM PREVENTION STRATEGIES Nutrition education and dietary diversification HORTICULTURAL INTERVENTION incl. Home gardening Nutritional supplementation Selective fortification for high risk and special groups

31. 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 Manual of neonatal care – john p cloharty, 6 th ed