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Multiple high dose vitamin A supplementation. A report on five cases

F J Rosales1, C L Kjolhede

  • 1Department of International Health, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland 21205.

Tropical and Geographical Medicine
|March 1, 1993
PubMed
Summary

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.

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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.

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  • 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.