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Diagnosing vitamin A deficiency and toxicity
Monitoring vitamin A therapy
The level of vitamin A in the plasma or serum is a reflection of the quantities of vitamin A and carotene (pro-vitamin A) ingested and absorbed by the intestine (carotene is converted to vitamin A by intestinal absorptive cells and hepatocytes).
Vitamin A plays an essential role in the function of the retina (adaptation to dim light), is necessary for growth and differentiation of epithelial tissue, and is required for growth of bone, reproduction, and embryonic development. Together with certain carotenoids, vitamin A enhances immune function, reducing the consequences of some infectious diseases.
Degenerative changes in eyes and skin are commonly observed in vitamin A deficiency. Poor adaptation of vision to darkness (night blindness) is an early symptom that may be followed by degenerative changes in the retina. In developing countries, vitamin A deficiency is the principal preventable cause of blindness. Severe or prolonged deficiency leads to dry eye (xerophthalmia) that can result in corneal ulcers, scarring, and blindness. Another important consequence of inadequate intake is acquired immunodeficiency disease, where an increased incidence of death is associated with deficient vitamin A levels. Increased susceptibility is associated with vitamin A deficiency. In patients with HIV, vitamin A deficiency is associated with increased disease progression and mortality.
Vitamin A in excess can be toxic. In particular, chronic vitamin A intoxication is a concern in normal adults who ingest >15 mg per day and children who ingest >6 mg per day of vitamin A over a period of several months. Manifestations are various and include dry skin, cheilosis, glossitis, vomiting, alopecia, bone demineralization and pain, hypercalcemia, lymph node enlargement, hyperlipidemia, amenorrhea, and features of pseudotumor cerebri with increased intracranial pressure and papilledema. Liver fibrosis with portal hypertension may also result. Congenital malformations, like spontaneous abortions, craniofacial abnormalities, and valvular heart disease have been described in pregnant women taking vitamin A in excess. Consequently, in pregnancy, the daily dose of vitamin A should not exceed 3 mg.
0-6 years: 11.3-64.7 mcg/dL
7-12 years: 12.8-81.2 mcg/dL
13-17 years: 14.4-97.7 mcg/dL
> or =18 years: 32.5-78.0 mcg/dL
The World Health Organization recommendations supplementation when vitamin A levels fall below 20.0 mcg/dL.
Severe deficiency is indicated at levels <10.0 mcg/dL.
Vitamin A values >120.0 mcg/dL suggest hypervitaminosis A and associated toxicity.
Acute ethanol ingestion may result in increased serum vitamin A levels.
Testing of nonfasting specimens or the use of vitamin supplementation can result in elevated plasma vitamin concentrations. Reference values were established in patients who were fasting.
1. Ball GFM: Vitamins: their role in the human body. Oxford, Blackwell Publishing, 2004, pp 133-187
2. Ross AC: Vitamin A and carotenoids. In Modern Nutrition in Health and Disease. 10th edition. Edited by ME Shils, M Shike, AC Ross, et al. Philadelphia, Lippincott Williams and Wilkins, 2006, pp 351-375