## Vitamin A Deficiency Management in Children ### Clinical Context This child presents with **corneal involvement (haziness) and Bitot's spots**, indicating moderate-to-severe vitamin A deficiency with risk of irreversible blindness. Serum retinol <20 µg/dL confirms biochemical deficiency. ### WHO/ICMR Protocol for Vitamin A Supplementation **Key Point:** The WHO and Indian Academy of Pediatrics recommend **high-dose oral vitamin A** for children with clinical signs of deficiency to rapidly restore retinol stores and prevent corneal scarring. | Severity | Serum Retinol | Management | Dosing | | --- | --- | --- | --- | | Mild (night blindness only) | 20–30 µg/dL | Oral supplementation | 200,000 IU once | | Moderate (Bitot's spots, corneal haze) | <20 µg/dL | **Oral high-dose** | **200,000 IU on days 1, 2, and 14** | | Severe (corneal ulcer/scarring) | <10 µg/dL | Oral + topical | 200,000 IU (3 doses) + ointment | ### Rationale for Correct Answer **High-Yield:** Oral vitamin A **200,000 IU** (not 100,000 IU) on **days 1, 2, and 14** is the **standard WHO protocol** because: 1. **Rapid restoration** of liver retinol stores within 48 hours 2. **Prevents corneal progression** to irreversible scarring 3. **Oral route** is preferred in non-severe cases (no IV needed unless severe malabsorption) 4. **Third dose at 2 weeks** ensures sustained levels during recovery **Clinical Pearl:** The 2-week interval for the third dose allows time for dietary improvement and prevents toxicity while maintaining therapeutic levels. ### Why Oral Over IV? IV vitamin A is reserved for: - Severe malabsorption (cystic fibrosis, celiac disease) - Inability to take oral medications - Corneal ulceration with risk of perforation This child can tolerate oral therapy. [cite:Park 26e Ch 10; WHO Micronutrient Deficiency Guidelines]
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.