Vitamin A and E Deficiency: Evaluation and Treatment
Clinical Recognition and When to Test
For vitamin A deficiency, check serum levels immediately if the patient reports night blindness, steatorrhea, protein malnutrition, or has undergone malabsorptive bariatric procedures (BPD/DS). 1, 2
For vitamin E deficiency, check serum levels if the patient presents with unexplained anemia, peripheral neuropathy (sensory/motor symptoms), muscle weakness, or hypotonia. 1, 2
High-Risk Populations Requiring Surveillance
- Post-bariatric surgery patients, especially those with malabsorptive procedures (BPD/DS), require vitamin A monitoring every 3 months until stable, then annually 1
- Post-bariatric surgery patients with malabsorptive procedures require vitamin E monitoring at least annually 1
- Patients with chronic steatorrhea or fat malabsorption syndromes warrant evaluation for both deficiencies 1
Treatment Protocols
Vitamin A Deficiency in Adults
Treat confirmed vitamin A deficiency with 10,000-25,000 IU oral vitamin A daily for 1-2 weeks, then recheck levels at 3 months. 1, 2, 3
- Administer vitamin A with lipid-containing meals or lipid emulsion to optimize absorption 4
- If no clinical improvement (particularly in night vision) or levels remain low, refer to a specialist for intramuscular vitamin A injections 1, 3
- For adolescents with vitamin A deficiency, specialist referral is mandatory 1
Critical safety consideration: Exclude pregnancy in women of childbearing age or use beta-carotene form instead of retinol if pregnancy is possible 4
Vitamin E Deficiency
Treat vitamin E deficiency with oral vitamin E 100-400 IU daily, then recheck levels after 3 months. 1, 2
- When assessing vitamin E nutritional status, adjustment must be made for serum lipids 1
- If deficiency persists despite oral treatment, refer to a specialist for assessment and consideration of intramuscular injections 1
Major pitfall: Large vitamin E doses can exacerbate vitamin K deficiency and affect blood coagulation—monitor coagulation parameters carefully 2
Monitoring Strategy Post-Treatment
Vitamin A
- Recheck serum vitamin A levels at 3 months after initiating treatment 1, 3
- Monitor for clinical improvement in night vision within 1-2 weeks 3, 4
- For patients with ongoing malabsorption, transition to prophylactic dosing of 10,000 IU daily for long-term maintenance 4
Vitamin E
- Recheck serum vitamin E levels at 3 months after treatment initiation 1
- Monitor for improvement in neurological symptoms and anemia 1, 2
- Continue annual monitoring in high-risk patients (post-bariatric surgery) 1
Concurrent Deficiency Investigation
When unexplained anemia or fatigue persists, investigate for additional nutritional deficiencies including protein, zinc, copper, and selenium—not just vitamins A and E. 1, 2
- Check both zinc and copper levels simultaneously, as they affect each other's absorption 1
- If both are low, consider prescribing two Forceval daily for 3 months and recheck levels 1
Common Pitfalls to Avoid
- Do not use prophylactic doses (6,000 IU daily) when vitamin A deficiency is clinically suspected—this underdoses the patient and delays recovery 4
- Do not delay treatment waiting for laboratory confirmation when clinical signs strongly suggest deficiency, particularly with night blindness or xerophthalmia 3, 5
- Do not prolong high-dose vitamin A supplementation beyond 1-2 weeks without reassessment—chronic toxicity can occur with daily amounts exceeding 25,000 IU for more than 6 years 4, 6
- Do not forget to check vitamin K status when treating vitamin E deficiency, especially in patients on anticoagulants 1, 2
Treatment Resistance Protocol
If vitamin A or E deficiency does not respond to standard oral treatment: