Pediatrics
Vitamins in Health and Disease
Pediatric vitamins for MBBS: vitamin A in measles, rickets, vitamin K deficiency bleeding, B-complex signs and scurvy, mapped to NMC codes under PE12.1 to PE12.21.
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Vitamins in Health and Disease
Pediatric vitamins for MBBS: vitamin A in measles, rickets, vitamin K deficiency bleeding, B-complex signs and scurvy, mapped to NMC codes under PE12.1 to PE12.21.
This chapter covers fat-soluble and water-soluble vitamins in health and disease, including vitamin A, D, E, K, the B complex and vitamin C, with their sources, deficiency features, diagnosis and management. It emphasises vitamin A in measles, rickets, vitamin K deficiency bleeding and the classic deficiency signs.
High-yield: Vitamins in Health and Disease
- Vitamin A supplementation reduces all-cause mortality in children aged 6 to 59 months by about 24 percent in at-risk populations.
- Every child with measles should receive vitamin A, 200,000 IU for children over 12 months given on Day 1 and Day 2, which can reduce measles mortality by up to 50 percent.
- Night blindness (nyctalopia) is the earliest ocular sign of vitamin A deficiency, progressing to Bitot spots, xerophthalmia and keratomalacia.
- The IAP recommends 400 IU per day of vitamin D3 for all Indian infants from birth, including exclusively breastfed infants, because breast milk is a poor source.
- Nutritional rickets from vitamin D deficiency causes wide wrists, rachitic rosary, bowing of legs and delayed closure of fontanelles.
- In rickets, alkaline phosphatase and parathyroid hormone are better early screening markers than serum calcium, which is often normal.
- An intercondylar distance above 5 centimetres indicates significant genu varum and an intermalleolar distance above 5 centimetres indicates significant genu valgum.
- Vitamin K deficiency bleeding shows prolonged prothrombin time and activated partial thromboplastin time with a normal platelet count and fibrinogen.
- The classic vitamin K deficiency bleeding scenario is an exclusively breastfed infant who did not receive vitamin K prophylaxis at birth.
- Prothrombin time is affected first in vitamin K deficiency because factor VII has the shortest half-life.
- Vitamin E deficiency in children should prompt thought of fat malabsorption or prematurity, as it essentially does not occur on a normal diet.
- In B-vitamin deficiency the tongue colour differs: magenta tongue in riboflavin (B2), beefy red tongue in niacin (B3), and a smooth pale sore tongue in B12 or folate deficiency.
- Thiamine (B1) deficiency causes beriberi, niacin (B3) deficiency causes pellagra with dermatitis, diarrhoea and dementia, and vitamin C deficiency causes scurvy.
- Scurvy from vitamin C deficiency features gum bleeding, subperiosteal haemorrhage, corkscrew hairs and impaired wound healing.
Classic vitamin deficiency signs
- **Vitamin A:** Night blindness, Bitot spots, xerophthalmia, keratomalacia.
- **Vitamin D:** Rickets: wide wrists, rachitic rosary, bowed legs; ALP and PTH rise early.
- **Vitamin K:** Bleeding with prolonged PT and aPTT, normal platelets and fibrinogen.
- **Vitamin C:** Scurvy: gum bleeding, subperiosteal haemorrhage, poor healing.
NMC competencies in this chapter
- **PE12.1:** Vitamin A: RDA, dietary sources and role in health and disease
- **PE12.2:** Vitamin A deficiency: causes, clinical features, diagnosis and management
- **PE12.5:** Vitamin A prophylaxis programme
- **PE12.6:** Vitamin D: RDA, dietary sources and role in health and disease
- **PE12.7:** Vitamin D deficiency: rickets and hypervitaminosis D
- **PE12.11:** Vitamin E: RDA, dietary sources and role
- **PE12.13:** Vitamin K: RDA, dietary sources and role
- **PE12.14:** Vitamin K deficiency bleeding: causes, features, diagnosis, management and prevention
- **PE12.15:** Vitamin B complex: RDA, dietary sources and role
- **PE12.16:** Vitamin B complex deficiency: clinical features, diagnosis and management
- **PE12.19:** Vitamin C: RDA, dietary sources and role
- **PE12.20:** Vitamin C deficiency: scurvy
Frequently Asked Questions
Why is vitamin A given in measles?
Vitamin A is given in every child with measles, 200,000 IU for children over 12 months on Day 1 and Day 2, because it can reduce measles mortality by up to 50 percent and prevent complications such as keratomalacia and blindness.
Why do vitamin D deficiency and rickets occur in India despite sunlight?
Rickets remains common because of dark skin, limited sun exposure, covering clothing, air pollution and low dietary vitamin D. The IAP recommends 400 IU per day of vitamin D3 for all Indian infants from birth.
What is the coagulation picture in vitamin K deficiency bleeding?
Vitamin K deficiency bleeding shows a prolonged prothrombin time and activated partial thromboplastin time with a normal platelet count and fibrinogen. Prothrombin time is affected first because factor VII has the shortest half-life.
How do B-vitamin deficiencies affect the tongue?
The tongue colour helps localise the deficiency: a magenta tongue suggests riboflavin (B2) deficiency, a beefy red tongue suggests niacin (B3) deficiency, and a smooth, pale, sore tongue suggests vitamin B12 or folate deficiency.
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