Vitamin A Solution
DR.BEMMA KONTHOUJAM
PGT-1
Vitamin A
2
It is a Fat soluble vitamin.
Carry out vital functions in the body.
Two Forms-Active form- Retinol(Preformed) and
Carotenoids(Provitamin)
Carotenoid are converted to Retinol in the intestine.
Retinol-Animal source, Beta- Carotene-Plant source
It is stable to heat at ordinary temperature but liable to oxidation and
destruction on rancidity of fat.
Storage – Human Liver has enourmous capacity to storage of Vit
3
A(Retinol Palmitate)
Sufficient to meet the needs for 6-9 months.
New born and young child-not much of the reserve.Therefore ,they are
more at the risk of developing deficiency.
Transport- free retinol is active and toxic.They are always transported
along with a binding protein- ‘Retinol binding protein’(produced by the
Liver
Decreases mobilization of liver retinol reserves in Protein deficiency and
liver diseases.
4
Vitamin A - Functions
It is vital for the synthesis of retinal pigment ‘Rhodopsin’ in rods of retina
of the eye,responsible for adaptation of vision in dark .
It is essential for maintaining the integrity of skin and mucous membranes of
conjunctiva,respiratory, gastrointestinal, genitourinary system.
It has a role in the immune defence mechanism of the body-Anti-infective.
It promotes growth-Skeletal growth.
It has antioxidant activity.
It may also protect some epithelial cancers – Ca of Bronchus.
Vitamin A - Sources
5
Animal sources(Retinol): meat, liver , kidney, milk, fish, and egg.
Richest source-Fish Liver oil(Cod liver oil and shark liver oil)
Vegetable Source(beta-Carotene) :Green leafy vegetables e.g;spinach,amaranth.Darker the
green colour-higher the carotene content.
Colored fruits and vegetables:yellow & orange vegetable and fruits ( e.g. pumpkins,
papaya, mango, apricots, yellow peaches.
Roots-Carrots(β- carotene)
Food heated for long time losses Vitamin A .Boiling , canning or freezing of food does
not cause loss and drying and dehydration do cause significant loss
6
Vitamin A – Deficiency
7
Two forms - Ocular & Extra-ocular
1.Ocular Manifestation- Most common- ‘Xeropthalmia’
2.Extra Ocular manifestation
Ocular Manifestation :
8 Night Blindness- Inability to see in dim light
m/c Complaint by the mother-The child cannot find her/see her in late
evening or in dark room.
The child dashes against the wall.
If not managed at this stage,it passes on to the next stage.
Conjuctival Xerosis:Normal Conjuctiva-Smooth,shiny.
Conjuctiva over the scelra becomes dry,dull and wrinkled-Smoky
appearance
Bitot’s spots-Traingular,foamy,pearly white or yellowish spots on Bulbar
conjunctiva,lateral to the cornea-usually B/L
Corneal Xerosis-Smooth,shiny transparent cornea looks dull and dry-later
opaque.If not Mx,it could lead to corneal ulceration- Medical emergency
Contd-
9 Corneal ulcer-Ulcer may be big or small,which after healing leaves
behind a permanent scar-Affects vision
Keratomalacia- Entire cornea or part of it becomes soft and later is
liquefied.The soft cornea may burst open,leading to prolapse of the
Iris,grave Medical emergency .If eye collapse-vision is lost.
10
VAD – Clinical feature
11
Extraoccular Manifestation:
12
Follicular Hyperkeratosis(phrynoderma)
Dry rough , itchy skin ; rash
Dry brittle hair and nails
Loss of appetite -Anorexia
low immunity –Increased incidence of respiratory and alimentary
infections
Poor growth
Recommendation (ICMR-2010)
13
Vitamin A Deficiency - Problem Statement
14
Vitamin A Deficiency(VAD) is the leading cause of preventable blindness in
children.
VAD is a public health problem in more than half the countries of Africa , and
South East Asia
World wide 256 million people suffer from preclinical xerophthalmia and 2.6
million develop xerophthalmia , 700,000 develop corneal ulcers and 350,000
become blind
In India it is common in preschool children in AP, TN, Karnataka, WB & Bihar.
An estimated of 5.7% children in India suffer from eye signs of VAD
VAD - Etiology
15
Most common age group affected – 1 to 3 year of age
A complex web of causation which includes , ignorance , poverty ,
infection , lack of food, malnutrition , environmental factors and
social factors.
Weaning and infection
Other Social factors
Poor Environmental sanitation Practices
Treatment & Prevention for Xeropthalmia
16
Nearly all stages of Xeropthalmis can be reversed by single massive dose of 200,000
IU(110mg) of Retinol palmitate ( Vitamin A in oil)administered orally for 2 days and then
after 14 days(THERAPEAUTIC DOSE)
For children more than 1 year but less than 8kgs:100,000 IU of Vit A.
National Programme for prevention of nutritional
17
Blindness – India
A) Promoting consumption of Vitamin A rich foods by pregnant and
appropriate breast feeding.
B)Administration of massive dose of vitamin A upto 5 years of age
First dose of 100,000 IU with measles vaccine at 9 months
Subsequent doses of 200,000 IU each year every 6 months upto the age
of 5 years.
It is given with measles vaccine for programme feasibility
For prevention
18 Dietary modification
Nutritional education
Fortification-Vanaspati,margarine,milk.etc.
Periodic dosage – given with immunization programme.
Long term action-eliminate contributing to ocular disease e.g.,
persuading people in general,mother in particular to consume
generously dark green leafy vegetables,promotion of breast
feeding,improvement in environmental health-safe and adequate
water supply,sanitary latrines,social and health education.
Preparation:Vitamin A is a fat soluble,it is prepared in oil
19
solution.It is unstable and gets oxidized when it comes in contact
with air.It is very sensitive to heat and sunlight and therefore it is
stored in dark places.
Toxicity – Hypervitaminosis A
20
Acute Hypervitaminosis can occur by a single dose of vitamin A more
than 200mg.
Chronic misuse of supplement more than 4000RE( retinol equivalent ; 1IU
vitamin A = 0.3RE) for infants and 7000RE for adult.
Large amount more than 100 times the requirement can overwhelm the
liver and produce intoxication
It is characterized by nausea,vomiting,anorexia and sleep disorder f/b skin
desquamation, dry lips, dryness of nasal mucosa , peeling of skin .
The teratogenic effects of massive doses of vit A-most recent focus of
interest.
21
THANK YOU
