Pediatrics Dr. Nawal
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VITAMINS
VITAMIN A DEFICIENCY
Clinical Manifestations
The most obvious symptoms ( the maintenance of epithelial functions).
skin :- dry, scaly, hyperkeratotic patches, commonly on the arms, legs,
shoulders, and buttocks.
The combination of defective epithelial barriers to infection, low immune
response, and lowered response to inflammatory stress, can cause poor growth
and serious health problems in children.
eye lesions : The most characteristic and specific signs. rarely occur before 2 yr
of age. Retina An early symptom is delayed adaptation to the dark; later leads
to night blindness due to the absence of retinal in the visual pigment,
rhodopsin, of the retina. Photophobia is a common symptom.
As vitamin A deficiency progresses, the epithelial tissues of the eye become
severely altered.
Cornea early the cornea keratinizes, becomes opaque, is susceptible to
infection, and forms dry, scaly layers of cells (xerophthalmia).
In later stages, infection occurs, the cornea becomes wrinkled; it degenerates
irreversibly (keratomalacia), resulting in blindness.
The conjunctiva keratinizes and develops plaques (Bitot spots, it becomes dry
(conjunctival xerosis), and the lacrimal glands keratinize
poor overall growth, diarrhea, susceptibility to infections, anemia, apathy.
mental retardation.increased intracranial pressure with wide separation of the
cranial bones at the sutures.
Pediatrics Dr. Nawal
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Prevention
The daily recommended dietary allowance:
for infants 0–1 yr of age is 400–500 μg.
3 yr of age: 300 μg; 4–8 yr of age: 400 μg.
9–13 yr of age, 600 μg.
Premature infants have poor lipid absorption; thus, they should receive water-
miscible vitamin A and should be monitored closely.
Treat
A daily supplement of 1,500 μg of vitamin A for latent vitamin A deficiency.
In children without overt vitamin A deficiency, morbidity and mortality rates
from viral infections such as measles can be lowered by daily administration of
1,500–3,000 μg of vitamin A.
Xerophthalmia : 1,500 μg/kg orally for 5 days followed by IM injection of 7,500
μg of vitamin A in oil, until recovery
Hypervitaminosis A
• Excess intake of vit.A for months or years
• Headache, vomitting, ↑ICP.
• Dry desquamating skin.
• Dry mucous membrane
• Alopecia.
• hepatosplenomegali
• XR : cortical hyperostosis
• TREAT: withdrawal of vitamin
Pediatrics Dr. Nawal
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THIAMINE DEFICIENCY(B1)
CLINICAL MANIFESTATIONS
Early:- poor mental concentration. peripheral neuritis, with tingling, burning,
and paresthesias of the toes and feet; decreased deep tendon reflexes; loss of
vibration sense.tenderness and cramping of the leg muscles; congestive heart
failure; and psychic disturbances. Hoarseness or aphonia caused by paralysis of
the laryngeal nerve. Muscle atrophy ataxia, loss of coordination, and loss of
deep sensation.
.
Later signs include increased intracranial pressure, meningismus, and coma
A severe deficiency beriberi. Two forms exist:-
wet beriberi (cardiac type), odema.
dry beriberi(neuretic).
Death from thiamine deficiency usually is secondary to
cardiac involvement. without prompt treatment, cardiac failure can develop
rapidly and result in death.
PREVENTION
A maternal diet containing sufficient amounts of thiamine prevents thiamine
deficiency in breast-fed infants.
infant formulas marketed in all developed countries provide recommended
levels of intake.
After that adequate intake can be achieved with diet that includes meat and
enriched or whole-grain cereals.
TREATMENT
If beriberi develops in a breast-fed infant, both the mother and the child should
be treated with thiamine. The daily dose for children is 10 mg oral.
cardiac failure :- should be given thiamine intramuscularly or intravenously.
Dramatic improvement usually occurs, but complete cure requires several
weeks of treatment. The heart is not permanently damaged
Pediatrics Dr. Nawal
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NIACIN DEFICIENCY
Pellagra, corn (maize), a poor source of tryptophan, is the major foodstuff
CLINICAL MANIFESTATIONS
The early are vague After a long period of deficiency, the classic triad of
dermatitis, diarrhea, and dementia appears.
Dermatitis( most characteristic), may be elicited
by irritants( intense sunlight).
The lesions first appear as symmetric areas of erythema on exposed surfaces,
usually sharply demarcated .
The lesions on the hands often have the appearance of a glove .
on the foot and leg (pellagrous boot).
around the neck (Casal necklace).
The cutaneous lesions may be accompanied by stomatitis, glossitis, vomiting,
and/or diarrhea.
Nervous symptoms include depression, disorientation, insomnia, and
delirium
PREVENTION
• consumption of a diet that consists of a variety of foods and includes
meat, eggs, milk, and enriched or fortified cereal products.
• Supplements of niacin are necessary only in breast-fed infants whose
mothers have pellagra or in children consuming very restricted diets
TREATMENT
Children usually respond rapidly to treatment.
diet should be supplemented with 50–300/day of niacin.
in severe cases 100 mg may be given IV.
Sun exposure should be avoided during the active phase.
the skin lesions may be covered with soothing applications.
Hypochromic anemia, treated with iron.
diet should be monitored to prevent recurrence