A in severe malnutrition
see also/voire aussi : Vitamin A supplementation and vitamin A deficiency in Zambia
|Vit A dosage||Fabienne Vautier||17.12.99|
|Re: vit A administration||G H Beaton||21.12.99|
|Vitamin A in severe malnutrition||Ben Torun||24.12.99|
Date: Mon, 13 Dec 1999 13:42:25 +0000
From: Fabienne_VAUTIERatgeneva.msf.org (fabienne vautier)
Subject: Vit A dosage
We are working now in the revision of the MSF nutrition guide-line. We have few questions about the supplmentation in Vit A.
1. Dosage of the Vitamine A for the severely malnourished children.
In the medical books, the dosages of vitamine A are given by age. But for the severely malnourished children, do we can consider the age or will it be better to calculate the dosage based on the body weight?
For example, 50 000 IU < 7 kg; 100 000 IU for 7 - 10 kg; 200 000 IU > 10 kg ?
2. Measles and vitamine A
In the Vitamin A supplement guide-line of WHO, 1997, it is recommanded to give 1 dose of Vitamine A for the children with measles if they have not already received a dose within 30 days.
All the malnourished children admitted in feeding centre receive one dose of Vit A at the admission. But for the malnourished children with measles, what do you think about a second doses of Vit A ?
Thank you very much for any advices on this topic.
From: GEORGE H BEATON <g.beatonatutoronto.ca>
Subject: Re: vit A administration <fwd>
Date: Tue, 21 Dec 1999 11:51:45 -0500
GEORGE H BEATON <g.beatonatutoronto.ca> on 12/17/99 10:10:24 AM
To: Barbara Underwood
Subject: vit A administration
This is directly in your ball park. I urge you to respond
--- Begin Forwarded Message ---
Date: Tue, 21 Dec 1999 10:39:32 -0500
From: Barbara Underwood <bunderwoatnas.edu>
Subject: Re: vit A administration
I am not a part of this group so am unsure just who should receive my response.
I will send it to you with the expectation that you can forwarded through the appropriate channel.
1. Dosage of vitamin A for the severely malnourished children:
In my view, I agree that for severe PEM, dosage is best based on weight rather than age until evidence of recovery is obvious. The age dosage recommendation assumes relatively adequate health status. With PEM there is a problem of restoring normal functioning, including protein synthesis of retinol-binding protein and transthyretin for carrying vitamin A. If the vitamin is stored in the liver, this would occur as these carrier proteins are restored. However, there is no assurance of liver stores and therefore, it is only safe to provide vitamin A supplement together with the needed therapeutic diet. Restoring growth increases need for vitamin A, and without it vitamin A deficiency can be rapidly precipitated, including clinical eye signs.
On the other side, severe PEM is associated with some liver disfunction and reduced ability to handle high doses of nutrients. My view is that a dosage based on weight is less likely to cause any risk of acute overdose, even though symptoms from acute overdose--nausea, vomiting, headache or bulging fontonnel--are transient with no lasting physiological consequences. Because of the possible problem of malabsorption and malutilization in severe PEM, the patient should be closely monitored following giving the dose and the dose repeated within two weeks if the patient has not shown a response.
2. Measles and vitamin A
I agree that for the malnourished child with measles, a second dose of vitamin A is advisable.
President, International Union Nutritional Sciences Scholar-in-Residence, Insititute of Medicine, National Academies
Date: Tue, 21 Dec 1999 15:09:12 +0000
From: "Dr. Benjamin Torun" <btorunatincap.org.gt>
Subject: Vitamin A in severe malnutrition
It is easier to use age as the criterion for dosage, and this is what most publications recommend. Although there are some minor differences in the grouping by age, I suggest to be consistent with the recommendations in the WHO 1999 manual:
Less than 6 months old: 50,000 IU (15 mg retinol equivalents) 6- 12 months: 100,000 (30 mg r.e.)
More than 12 months: 200,000 (60 mg r.e)
This dose must be given on the day of admission. When there are ocular signs of vitamin A deficiency, the dose must be repeated on days 2 and 15.
For severely malnourished children admitted with measles, I suggest repeating the dose on day 2.
If the child's condition allows it, vitamin A should be given orally, either as oil-based or water-miscible preparations. Otherwise, give it IM in water-miscible preparation.