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Multiple high dose vitamin A supplementation. A report on five cases
1Department of International Health, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland 21205.
Insights
High-dose vitamin A supplementation in young children with measles and other illnesses did not cause toxicity. This finding addresses concerns about vitamin A dosing in vulnerable populations.
Area of Science:
- Pediatrics
- Nutritional Science
- Public Health
Background:
- Vitamin A toxicity is a clinical concern, particularly with current recommendations potentially leading to over-supplementation in short periods.
- Accurate vitamin A dosing is crucial for infants and children, especially those with multiple co-existing health conditions.
Observation:
- Five children aged 8 months to 5 years, participating in a community trial for vitamin A during acute measles, were treated for severe acute respiratory infection, malaria, and/or diarrhea.
- One 12-month-old received a cumulative dose of 1,612,500 IU of vitamin A over three weeks.
- Elevated serum retinol levels (3.42 umol/l) were noted in the 12-month-old, but no clinical signs of vitamin A toxicity were observed in any of the five children.
Findings:
- Multiple high doses of vitamin A were administered to children with acute measles and other severe illnesses.
- No overt signs of vitamin A toxicity were observed in any of the participants despite high cumulative doses.
- Serum retinol levels were elevated in one case but did not correlate with toxicity symptoms.
Implications:
- The study suggests that under specific clinical conditions and with concurrent illnesses, children may tolerate higher vitamin A doses than previously assumed.
- Clarifies the potential for safe administration of vitamin A in complex pediatric cases, challenging existing toxicity concerns.
- Highlights the need for further research and case reporting on vitamin A dosing in critically ill children, as formal clinical trials are ethically challenging.
Abstract:
Vitamin A toxicity is a concern among health care providers, especially when present recommendations for vitamin A may result in multiple dosing during a short period of time. We observed no vitamin A toxicity in 5 children who received multiple high doses of vitamin A. These 8-month to 5-year-old children were part of a community trial of vitamin A during acute measles, and were being treated at a local hospital for severe acute respiratory infection, malaria, and/or diarrhoea. One 12-month-old who received 1,612,500 I.U. within a period of three weeks showed elevated serum retinol (3.42 mumol/l), but none of the five showed signs of toxicity. These cases illustrate the confusion surrounding the correct use of vitamin A for infants and children with multiple morbid conditions. A plea is made to report similar situations since clinical trials are unethical.