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