Vitamin A Deficiency Replacement
For adults with vitamin A deficiency, treat with 10,000-25,000 IU oral vitamin A daily for 1-2 weeks, then recheck levels at 3 months. 1
Adult Treatment Protocol
- Start with oral vitamin A 10,000-25,000 IU daily for 1-2 weeks for clinical improvement in adults with documented deficiency 1
- Recheck vitamin A levels at 3 months after completing the initial treatment course 1, 2
- If deficiency persists despite oral treatment, refer to a specialist for assessment and consideration of intramuscular vitamin A injections 1, 2
Special Circumstances Requiring Higher Doses
- For patients with night blindness or active xerophthalmia, higher doses including intramuscular injections may be needed immediately 1
- Consider ophthalmology referral if visual symptoms are present 1
Pediatric Treatment Protocol
Children with Clinical Xerophthalmia (Eye Symptoms)
The CDC recommends a specific three-dose regimen for children with eye symptoms of vitamin A deficiency 2:
- Day 1: 200,000 IU oral vitamin A 2
- Day 2: 200,000 IU oral vitamin A 2
- 1-4 weeks later: 200,000 IU oral vitamin A 2
- For infants <12 months: Use half doses (100,000 IU) at each time point 2
Adolescents
- Refer adolescents with vitamin A deficiency for specialist support as there are no established guidelines for vitamin A replacement in this age group 1, 2
Monitoring and Follow-Up
- Document all vitamin A doses on the child's growth record chart 2
- Monitor for clinical improvement in night vision and other deficiency symptoms 2
- Recheck serum vitamin A levels at 3 months in adults to ensure adequate repletion 1, 2
Important Clinical Considerations
When to Suspect Vitamin A Deficiency
Measure vitamin A levels in patients with 1:
- Chronic liver disease (prevalence increases with disease severity) 1
- Chronic alcohol consumption (depletes liver stores despite potentially normal serum levels) 1
- Chronic kidney disease (though high levels may occur initially, stores can become depleted) 1
- Short bowel syndrome, cystic fibrosis, celiac disease, or chronic diarrhea (reduced fat absorption) 1
- Visual symptoms including night blindness or xerophthalmia 1
Treatment-Resistant Cases
- If oral supplementation fails, intramuscular administration may be necessary 1, 2
- Investigate for underlying malabsorption or other causes of persistent deficiency 2
- Specialist referral is mandatory for non-responsive cases 1
Safety Considerations
Toxicity Risk
- Acute toxicity occurs with >300,000 IU in adults or >60,000 IU in children within hours to days 1
- Chronic toxicity develops with >25,000 IU daily for >6 years or >100,000 IU for >6 months 1
- Symptoms of acute toxicity include increased intracranial pressure, headache, nausea/vomiting, vertigo, and blurred vision 2
- Chronic toxicity presents with bone abnormalities, dermatitis, and alopecia 2
Pregnancy Considerations
- Avoid excessive vitamin A in pregnancy as both deficiency and excess can cause congenital malformations 1
- The upper limit for women of childbearing age is 3,000 mcg/day (10,000 IU) 1
Parenteral Nutrition Considerations
- For patients on parenteral nutrition, vitamin A should be given with lipid emulsion whenever possible to minimize losses 1
- Substantial losses occur when vitamin A is given with water-soluble solutions due to photo-degradation and adsorption to tubing 1
- Use light-protecting material during administration 1