From the Guidelines
To replete vitamin A deficiency, start with oral supplementation using retinol (preformed vitamin A) at a dose of 10,000-25,000 IU daily for 1-2 weeks, as recommended by the British Obesity and Metabolic Surgery Society guidelines 1. This approach is supported by multiple studies, including the 2020 update on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery 1. The key points to consider when repleting vitamin A deficiency include:
- Oral supplementation with vitamin A at a dose of 10,000-25,000 IU daily for 1-2 weeks for clinical improvement 1
- Rechecking vitamin A levels at 3 months to assess the response to treatment 1
- Considering referral to a specialist for assessment and potential intramuscular vitamin A injections if the deficiency does not respond to oral treatment 1
- Monitoring for symptoms such as night blindness, dry eyes, or skin changes, and adjusting the supplementation dose as necessary 1 It is essential to note that vitamin A is fat-soluble and stored in the liver, so excessive supplementation can lead to toxicity; therefore, it is crucial to avoid doses above recommended levels without medical supervision 1. Additionally, pregnant women should not take high-dose vitamin A supplements due to potential teratogenic effects. Good dietary sources to maintain vitamin A levels include liver, fish oils, egg yolks, dairy products, and orange/yellow vegetables and fruits (containing beta-carotene, which converts to vitamin A) 1. For those with malabsorption conditions like celiac disease or pancreatic insufficiency, water-miscible forms of vitamin A may be more effectively absorbed 1.
From the Research
Vitamin A Deficiency Repletion
To address vitamin A deficiency, several strategies can be employed:
- Supplementation: Prophylactic vitamin A supplements should be given to all infants and young children (0-59 mo), pregnant women, and postpartum women within 6 wk after delivery, as recommended by the International Vitamin A Consultative Group (IVACG) 2.
- Dietary Intake: Consuming foods rich in vitamin A, such as animal products, and provitamin A carotenoids, like β-carotene, from plant sources can help maintain adequate vitamin A levels 3, 4.
- Food Fortification: Fortifying foods like oil, cereal flours, and sugar with vitamin A can be an effective way to increase micronutrient supply and reduce vitamin A deficiency, especially in developing countries 5.
- High-Dose Vitamin A Treatment: Immediate high-dose vitamin A treatment is recommended for active corneal xerophthalmia, severe malnutrition, or measles, while low-dose vitamin A treatment is recommended for women with night blindness and/or Bitot's spots 2.
Special Considerations
Certain populations may require special attention:
- Infants and Young Children: Three 50,000-international unit (IU) doses of vitamin A should be given at the same time as infant vaccines during the first 6 mo of life 2.
- Pregnant and Lactating Women: Vitamin A needs are quantified, and toxicity in early pregnancy is stressed, highlighting the importance of careful supplementation 4.
- Patients with Immunodeficiency: Assessing and addressing micronutrient deficiencies, including vitamin A, is crucial in patients with common variable immunodeficiency (CVID) to prevent disease aggravation and chronic inflammation 6.