Question
A 10 month old child weighing 8kg has this condition in both eyes. Which of the following is the most appropriate schedule to prescribe the deficient vitamin to this child –
A. 2 lakh units intramuscular (IM) on day 0, 14
B. 1 lakh units IM on day 0, 14
C. 2 lakh units IM on day 0, 1 and 14
D. 1 lakh units IM on day 0, 1 and 14
Show Answer
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Correct Answer » D Explanation |
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Ans:D.1 lakh units IM. on day 0, 1 and 14
The patient is presenting with Bitot’s Spot due to Vitamin A deficiency.
Vitamin A
- It is a fat-soluble vitamin.
- Causes of Vitamin A deficiency include causes of Vitamin A deficiency are inadequate intake, fat malabsorption, or liver disorders
- The ocular manifestations of vitamin A are collectively called xerophthalmia .It can affect any age group, but its most severe blinding complications affect children aged 6 months to 3 years.
The WHO classification of vitamin A deficiency is as follows:
- XNNight blindness:Night blindness is the earliest clinical symptom
- X1A Conjunctival xerosis
- XIB Bitot’s spot : Bitot’s spots are the buildup of keratin located superficially in the conjunctiva, which are oval, triangular or irregular in shape.
- X2 Corneal xerosis
- X3A Corneal ulceration/keratomalacia involving one-third or less of the cornea
- X3B Corneal ulceration/keratomalacia involving one-half or more of the cornea
- XS Corneal scar
Treatment
- Oral therapy: The oral regimen of vitamin A is 200,000 IU on day of presentation, next day, and 2-4 weeks later.
- Children less than 1 year of age or less than 8 kg should receive half the dose of the above dose. Repeat 200,000 IU every 6 months up to 6 years of age to prevent recurrence.
- Parenteral therapy: If the patient has severe disease, is unable to take oral feeds, or has malabsorption, the preferable dose is 100,000 IU of vitamin A given intramuscularly.
- Children with severe measles should also receive vitamin A as they are very likely to be benefited from such therapy both in terms of saving sight and reducing case fatality.
Prevention
- Prophylaxis consists of periodic administration of Vitamin A supplements. WHO recommended schedule, which is universally recommended is as follows:
- Infants 6–12 months old and any older children weighing less than 8 kg – 100,000 IU orally every 3–6 months
- Children over 1 year and under 6 years of age – 200,000 IU orally every 6 months
- Infants less than 6 months old, who are not being breastfed – 50,000 IU orally should be given before they attain the age of 6 months