Vitamin A Deficiency – Causes & Symptoms

 

Vitamin A (retinol) is required for the formation of rhodopsin, a photoreceptor pigment in the retina. Vitamin A helps maintain epithelial tissues. Normally, the liver stores 80 to 90% of the body’s vitamin A. To use vitamin A, the body releases it into the circulation bound to prealbumin (transthyretin) and retinol-binding protein. ?-Carotene and other provitamin carotenoids, contained in green leafy and yellow vegetables and deep- or bright-colored fruits, are converted to vitamin A. Carotenoids are absorbed better from vegetables when they are cooked or homogenized and served with some fat (eg, oils).

VITAMIN A DEFICIENCY

Vitamin A deficiency can result from inadequate intake, fat malabsorption, or liver disorders. Deficiency impairs immunity and hematopoiesis and causes rashes and typical ocular effects (eg, xerophthalmia, night blindness). Diagnosis is based on typical ocular findings and low vitamin A levels. Treatment consists of vitamin A given orally or, if symptoms are severe or malabsorption is the cause, parenterally.

Causes

Primary vitamin A deficiency is usually caused by

  • Prolonged dietary deprivation

It is endemic in areas such as southern and eastern Asia, where rice, devoid of ?-carotene, is the staple food. Xerophthalmia due to primary deficiency is a common cause of blindness among young children in developing countries.

Secondary vitamin A deficiency may be due to

  • Decreased bioavailability of provitamin A carotenoids
  • Interference with absorption, storage, or transport of vitamin A

Interference with absorption or storage is likely in celiac disease, cystic fibrosis, pancreatic insufficiency, duodenal bypass, chronic diarrhea, bile duct obstruction, giardiasis, and cirrhosis. Vitamin A deficiency is common in prolonged protein-energy undernutrition not only because the diet is deficient but also because vitamin A storage and transport is defective.

In children with complicated measles, vitamin A can shorten the duration of the disorder and reduce the severity of symptoms and risk of death.

Symptoms and Signs

Impaired dark adaptation of the eyes, which can lead to night blindness, is an early symptom. Xerophthalmia (which is nearly pathognomonic) results from keratinization of the eyes. It involves drying (xerosis) and thickening of the conjunctivae and corneas. Superficial foamy patches composed of epithelial debris and secretions on the exposed bulbar conjunctiva (Bitot spots) develop. In advanced deficiency, the cornea becomes hazy and can develop erosions, which can lead to its destruction (keratomalacia).

Keratinization of the skin and of the mucous membranes in the respiratory, GI, and urinary tracts can occur. Drying, scaling, and follicular thickening of the skin and respiratory infections can result. Immunity is generally impaired.

The younger the patient, the more severe are the effects of vitamin A deficiency. Growth retardation and infections are common among children. Mortality rate can exceed 50% in children with severe vitamin A deficiency.



	

				
	

				





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