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ARTICLE
Year : 1983  |  Volume : 31  |  Issue : 5  |  Page : 654-655

Serum vitamin A levels after administration of aquous & oil vitamin A preparations in normal children & children with protein-energy malnutrition


R.T.N. Medical College, Udaipur, India

Correspondence Address:
M R Jain
R.T.N. Medical College, Udaipur
India
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Source of Support: None, Conflict of Interest: None


PMID: 6423535

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How to cite this article:
Jain M R, Lodha V, Nagar C K. Serum vitamin A levels after administration of aquous & oil vitamin A preparations in normal children & children with protein-energy malnutrition. Indian J Ophthalmol 1983;31:654-5

How to cite this URL:
Jain M R, Lodha V, Nagar C K. Serum vitamin A levels after administration of aquous & oil vitamin A preparations in normal children & children with protein-energy malnutrition. Indian J Ophthalmol [serial online] 1983 [cited 2019 Dec 11];31:654-5. Available from: http://www.ijo.in/text.asp?1983/31/5/654/36620

Presently two typos of vitamin A prepara­tions are available for systemic use, l) vitamin A in oily solution and 2) vitamin A in water­miscible form. Much divergence of opinions exists regarding the type of preparation to be favoured and the route of administration. Recently the trend has been towards the use of water-miscible form of vitamin A for the initial dose in the treatment of acute hypovitaminosis A, but comparable results have been claimed by Somer et al. (1980) with the use of oil­miscible form of vitamin by oral route. Though many studies have been conducted in this regards by McLaren (1965), Pereira & Begum (1967), Srikantia & Reddy (1970) Shivkumar & Reddy (1972), Bauerfeind et al. (1974) Anbunnathan & Pierie (1979) and Sommer et al. (1980), the present study was undertaken to further evaluate the efficacy of various vitamin A preparations used frequently in this country.


  Material and Methods Top


Eighty children (5-15 years) selected randomly from Udaipur region were included in the study out of which 40 were normal healthy children and 40 were suffering from various grades of protein-energy malnutrition. Each group was further divided into four groups and each child received 100,000 LU. of vitamin A, as follows:

1) Group I -Oil-miscible vitamin A (Tab. Arovit) orally.

2) Group II -Oily-solution of vitamin A (Inj. Arovit) intramuscularly.

3) Group III-Water-miscible vitamin A (cap Aquasol A) orally.

4) Group IV--Water-miscible vitamin A (Inj. Aquasol A) I.M.

Two blood samples were taken in the fasting state, one before and another at approximately 24 hours after administration of vitamin A. Serum vitamin A estima­tion was done by the method based on selective ultra. violet destruction of vitamin A (Bassey et al. 1946).


  Observations Top


The data of the study are summarised in the [Table 1]. The mean serum levels observed in our study were 32.63 ug/100 ml. in 40 healthy children and 25.52 ug/100 ml in children with P.E.M. (mostly grades II and II1). The serum levels in both the groups were within normal range as per recommendations of the United States Inter Departmental Committee on Nutrition for National Defence (IC NND, 1963) though on slightly lower side in children with P.E.M. The normal levels in children with P.E.M. were probably due to the reasons that the children were not suffering from severe grades of P.E.M. and only a few of them showed signs of Vit. A deficiency.

The rise in serum vitamin A levels after administration of various preparations were similar in healthy children and children with P.E.M. (most of cases had Gr. II or III of P.E.M.


  Discussion Top


Water-miscible vitamin A administered orally raised serum vitamin A levels much higher than when oil-miscible vitamin A was given orally. Mahadevan et al. (1965) suggested that low serum levels after oral administration of vitamin A in oil were due in part to the lowering of the betalipoprotein fraction of serum proteins, the fraction necessary for the transport of Vit. A given orally is absorbed to a higher extent, it shows that some other factors are also involved in defective absorption of oil-miscible form of vitamin A. McLaren (1958.) explained the effect of protein deficiency on various stages of Vitamin A metabolism as follows:

1. Defective absorption because the concentration of pancreatic and intestinal enzymes tend to fail along with some histological changes in these structures.

2. Conversion of carotenoids to vitamin A may be impaired.

3. Vitamin A is transported in blood in association with prealbumin, the level of which may fall in protein deficiency.

4. Storage and utilisation of vitamin A are also hampered in malnutrition.

Jain & Tahiri (1978) also observed that serum vitamin A levels were low (24-70 ug/ 100 ml) in children with protein energy mal­nutrition as compared to the levels in normal serum 38.40 ug/100 ml. As vitamin A in oil­miscible form failed to raise serum levels to a significant extent as compared to water-miscible form in normal healthy children as well as it can be assumed that some other factors, as yet unknown are responsible for less absorption and/or rise in serum vitamin A levels when oil-miscible form is used.

When an oily solution of vitamin A is injected I.M., it is absorbed very poorly as was also observed by McLaren et al. (1965), Pereira and Begum (1967), and Srikantia and Reddy (1970).

The poor absorption of this form may be due to defective absorption of the oily base rather than the vitamin itself. Water miscible vitamin A when given intramuscularly raised serum levels to a very high extent often exceed­ing the normal range. Hence it poses a problem of potential danger of producing acute toxicity and this danger becomes more significant in the hand of auxiliary health workers when larger doses may be administered inadvertantly.

In this country, water-miscible vitamin is manufactured by only one company and quite often its availability is scarce. This limits its scope of utility but ideally the choice for peophylaxis should be oral water miscible vitamin A and it's imperative to use water miscible forms intramuscularly in acute vitamin A deficiency like keratomalaria it is stressed that protein therapy must be supplemented in all these cases for good results since there is a close correlation between protein calorie malnutrition and vitamin A deficiency.




 

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