DR. PAVAN HEGDE.
Globally 21% of children have vit A
About 8,00,000 deaths in children and
women of reproductive age are due to vit A
1.8% of global DALYs
1. For normal VISION
2.For normal maintenance and function of body
3.Maintenance of cellular integrity , immune
competence , and growth….
5.Retinol is needed for spermatogenesis and and
integrity of testicular & vaginal epithelium…
6. Antioxidant function
1.ANIMAL FOODS-liver, eggs, butter , cheese
,milk , fish and meat…fish liver oil.
2.PLANT FOODS- green leafy vegitables.
Red palm oil
Green & yellow fruits and veg( papaya,
Some roots (carrots)
INFANTS- 300- 400 micro g.
CHILDREN -400-600 micro g.
ADOLECENTS – 750 micro g.
2. Decreased absorption- diarrhea, worms &
3. Increased demand- in measles, febrile
infection, resp inf
4. PEM - protien defficiency- RBP
5.Preterm babys-have low retinol level
1. Subclinicall defi- RS ,UT, intestinal
epithelium , and immune system are
It contributes to an increased severity of
2 Early features- Defective dark adaptation.
3.Xerophalmia-- prevalent in 6 to 36 mts olds.
X1A- Conjunctival xerosis
X3A-Corneal ulceration < than 1/3 of cornea
X3B- Corneal ulceration > than 1/3 of cornea
XN- Night blindness
XF- Fundal changes
Conjunctival xerosis – loss of lustre & moist
appearance. It looks dry & wrinkled
Bitots spots- chalky grey spots on the temp
side of corneo scleral junctions…
Keratomalacia –softening & ulceration of
Xerophalmia fundus- pale yellow spots
4. Other features-
- Skin scaly & toad like
-more prone for infection
-renal & vesicular calculi
- interfers with reproductive function…
- rarely hydrocephalus
SPECIFIC - immediately after diagnosis ,oral Rx
<6 months-50,000 IU
6-12 months-1 lakhIU
> 1 yr - 2 lakh IU
same dose NEXT DAY & 4 WKS later
Parenteral in case of impaired oral intake
< 6 months- ¾ th of 50,000 IU
6-12 months – half of 1 lakh IU
LOCAL Rx – EYE CARE
antibiotic drop ,ointment should be
instilled 3 times to prevent infection
padding to prevent exposure keratitis . It
enhancess healing, reducess pain,
Children who are not breastfed- 50,000IU
vit A supplement by 2 months of age
Two dose of 25,000 IU vit A with 1 month
Every infant should take 1 lakh IU with
measles and 4 more doses of 2 lakh at 18, 24,
30, 36 months….
-In endemic area , children suffering from measles &
< 1yr- 1lakh IU
> 1yr- 2 lakh IU
Should be given for 2 consecutive days.
-Persitant diarrhea & other febrile illness
1 dose each episode , keeping at least 1month
interval b/n 2 doses
Medium term action- fortification of foods
Long term- nutritional education
- horticulture intervention
- nutritional supplementation
- improving the envirornmental
- diet – vit A rich foods