Vitamin A deficiency: Difference between revisions
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*One of the most common vitamin deficiencies in developing countries | *One of the most common vitamin deficiencies in developing countries | ||
*Most common cause of blindness in developing world | *Most common cause of blindness in developing world | ||
*In US, most commonly found in conjunction with fat malabsorption syndromes (e.g. [[IBD]], pancreatic insufficiency, sprue, [[cystic fibrosis]], laxative abuse) | *In US, most commonly found in conjunction with fat malabsorption syndromes (e.g. [[IBD]], pancreatic insufficiency, sprue, [[cystic fibrosis]], [[bulimia nervosa|laxative abuse]]) | ||
==Clinical Features== | ==Clinical Features== | ||
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**Night blindness (early) | **Night blindness (early) | ||
**Dry conjunctivae with small white patches (Bitot spots) | **Dry conjunctivae with small white patches (Bitot spots) | ||
**Corneal ulceration/necrosis (keratomalacia), perforation, [[endophthalmitis]], and blindness (late) | **[[corneal ulcer|Corneal ulceration]]/necrosis (keratomalacia), perforation, [[endophthalmitis]], and blindness (late) | ||
*Dry, hyperkeratinized skin, hair, and nails | *Dry, hyperkeratinized skin, hair, and nails | ||
*[[Pruritus]] | *[[Pruritus]] | ||
Revision as of 16:57, 29 September 2019
Background
- One of the most common vitamin deficiencies in developing countries
- Most common cause of blindness in developing world
- In US, most commonly found in conjunction with fat malabsorption syndromes (e.g. IBD, pancreatic insufficiency, sprue, cystic fibrosis, laxative abuse)
Clinical Features
- Visual loss
- Night blindness (early)
- Dry conjunctivae with small white patches (Bitot spots)
- Corneal ulceration/necrosis (keratomalacia), perforation, endophthalmitis, and blindness (late)
- Dry, hyperkeratinized skin, hair, and nails
- Pruritus
- Loss of taste
Differential Diagnosis
Acute Vision Loss (Noninflamed)
- Painful
- Arteritic anterior ischemic optic neuropathy
- Optic neuritis
- Temporal arteritis†
- Painless
- Amaurosis fugax
- Central retinal artery occlusion (CRAO)†
- Central retinal vein occlusion (CRVO)†
- High altitude retinopathy
- Open-angle glaucoma
- Posterior reversible encephalopathy syndrome (PRES)
- Retinal detachment†
- Stroke†
- Vitreous hemorrhage
- Traumatic optic neuropathy (although may have pain from the trauma)
†Emergent Diagnosis
Vitamin deficiencies
- Vitamin A deficiency
- Vitamin B deficiencies
- Vitamin B1 deficiency (Thiamine)
- Vitamin B3 deficiency (Pellagra)
- Vitamin B9 deficiency (Folate)
- Vitamin B7 deficiency (Biotin)
- Vitamin B12 deficiency
- Vitamin C deficiency (Scurvy)
- Vitamin D deficiency (Rickets)
- Vitamin E deficiency
- Vitamin K deficiency
Evaluation
- Eye exam
- Serum Vitamin A level below 30–65 mg/dL
Management
- Early: vitamin A 30,000 IU PO daily x 1 week
- Advanced: vitamin A 20,000 IU/kg PO daily for at least 5 days