Vitamin A Deficiency in Children: Model Clinical Case and Viva Q&A

Clinical Case of Vitamin A Deficiency in Children

Case Presentation

A 4-year-old boy from a rural village in Southeast Asia is brought to the clinic by his mother. The child appears thin and lethargic. His mother reports that he has been experiencing recurrent diarrhea for the past three months and has recently developed difficulty seeing at night.

Physical Examination

• Weight: 12 kg (below 3rd percentile for age)
• Height: 95 cm (below 10th percentile for age)
• Pale conjunctiva and mucous membranes
• Dry, rough skin
• Bitot's spots on the conjunctiva
• Corneal xerosis

Laboratory Findings

• Serum retinol: 0.2 μmol/L (Normal range: 0.7-1.4 μmol/L)
• Hemoglobin: 9.5 g/dL
• Albumin: 2.8 g/dL

Diagnosis

Based on the clinical presentation, physical examination findings, and laboratory results, the child is diagnosed with severe Vitamin A deficiency complicated by protein-energy malnutrition and iron deficiency anemia.

Treatment

1. Immediate administration of oral vitamin A: 200,000 IU on day 1, repeated on day 2, and again after 2 weeks
2. Nutritional counseling and supplementation
3. Treatment of concurrent infections and anemia
4. Regular follow-up to monitor progress and prevent recurrence

Clinical Presentations of Vitamin A Deficiency

Varieties of Clinical Presentations in Vitamin A Deficiency

1. Ocular Manifestations (Xerophthalmia)

   • Night blindness (Nyctalopia)
   • Conjunctival xerosis
   • Bitot's spots
   • Corneal xerosis
   • Corneal ulceration
   • Keratomalacia
   • Xerophthalmic fundus

2. Cutaneous Manifestations

   • Follicular hyperkeratosis
   • Phrynoderma (toad skin)
   • Dry, rough, scaly skin
   • Poor wound healing

3. Respiratory System Involvement

   • Increased susceptibility to respiratory infections
   • Recurrent pneumonia
   • Bronchopulmonary dysplasia in premature infants

4. Gastrointestinal Manifestations

   • Persistent diarrhea
   • Malabsorption
   • Impaired intestinal mucosal integrity

5. Growth and Development Issues

   • Stunted growth
   • Developmental delays
   • Poor weight gain

6. Hematological Manifestations

   • Anemia (often coexisting with iron deficiency)
   • Impaired hematopoiesis

7. Immunological Dysfunction

   • Increased susceptibility to infections
   • Delayed wound healing
   • Impaired cellular and humoral immunity

Knowledge Check: Question and Answers for Medical Students & Professionals

This interactive quiz component covers essential viva questions and answers. It includes 30 high-yield viva questions with detailed answers.

Question 1 of 30

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