What is the treatment for Vitamin A (Vit A) deficiency?

Treatment of Vitamin A Deficiency

For adults with vitamin A deficiency, treat with 10,000-25,000 IU oral vitamin A daily for 1-2 weeks until clinical improvement, then recheck levels at 3 months. 1

Adult Treatment Protocol

• Initial treatment: Administer 10,000-25,000 IU oral vitamin A daily for 1-2 weeks for clinical improvement 1, 2
• Monitoring: Recheck vitamin A levels at 3 months after treatment 1, 2
• Treatment-resistant cases: If deficiency does not respond to oral treatment, refer to a specialist for assessment and consideration of intramuscular vitamin A injections 1, 2

Pediatric Treatment for Clinical Deficiency (Xerophthalmia)

When children present with eye symptoms of vitamin A deficiency (xerosis, Bitot's spots, keratomalacia, or corneal ulceration), this is a medical emergency requiring immediate high-dose treatment 1, 3:

• Day 1: 200,000 IU oral vitamin A 1, 2
• Day 2: 200,000 IU oral vitamin A 1, 2
• 1-4 weeks later: 200,000 IU oral vitamin A 1, 2
• Infants <12 months: Use half doses (100,000 IU per dose) 1, 2

Severe Malnutrition

All persons with severe malnutrition (weight-for-height Z-score <-3) should receive the full treatment schedule outlined above, regardless of whether eye symptoms are present 1

Preventive Supplementation in High-Risk Populations

When any of the following risk factors are present, provide preventive supplementation 1:

• Population originates from geographic area at high risk for vitamin A deficiency
• Evidence of severe vitamin A deficiency in the population
• General ration provides inadequate vitamin A (<2,000-2,500 IU/person/day)

Dosing schedule for prevention:

• Children 12 months to 5 years: 200,000 IU every 3 months 1, 2
• Infants <12 months: 100,000 IU every 3 months for 1 year (total 400,000 IU in first year) 1, 2
• Postpartum mothers: 200,000 IU within 2 months of giving birth to provide adequate vitamin A in breast milk 1, 2
• Pregnant women (if postpartum dosing not feasible): 100,000 IU during third trimester 1

Special Populations

Adolescents

• Refer for specialist support when vitamin A deficiency is identified 1

Cystic Fibrosis Patients

For pancreatic insufficient patients with CF, two approaches are recommended 1:

Option 1 - Preformed retinol:

• Start with low doses and adapt rapidly to target normal serum reference range 1
• Monitor serum levels to guide dosing 1

Option 2 - Beta carotene (safer option):

• 1 mg/kg/day (maximum 50 mg/day) for 12 weeks 1
• Follow with maintenance dose (maximum 10 mg/day) 1
• Beta carotene is subject to negative feedback control and therefore safer than preformed retinol 1

Pregnant Women

• Beta carotene form is preferred over retinol for prophylaxis during pregnancy 4
• Both hyper- and hypovitaminosis A can harm the mother and fetus 1
• Assess vitamin A intake and blood levels before conception or early in pregnancy 1

Critical Pitfalls to Avoid

Toxicity concerns:

• Factor in dietary intake when determining supplement dosing to avoid vitamin A toxicity 1
• Risk of hypervitaminosis A is higher with water-miscible and water-soluble forms than with oil-based supplements 1
• Acute toxicity can occur with doses >150,000 μg, presenting with increased intracranial pressure (headache, nausea/vomiting, vertigo, blurred vision) 2
• Chronic toxicity can occur with approximately 30,000 μg/day, presenting with bone abnormalities, dermatitis, and alopecia 2

Monitoring limitations:

• Serum vitamin A levels do not correlate well with tissue concentrations 1
• Do not assess vitamin A levels during acute phase of infection when serum retinol concentrations fall in response to inflammation 1

Documentation:

• Document all doses of vitamin A on the child's growth record chart 1, 2

Follow-Up and Monitoring

• Adults: Recheck vitamin A levels at 3 months after treatment 1, 2
• CF patients: Evaluate plasma levels 3-6 months after initiation or change in supplementation 1
• Annual monitoring: Once normal vitamin A levels are achieved, perform annual serum monitoring 1
• Monitor for clinical improvement in night vision and other symptoms of deficiency 1, 2