Micronutrients Deficiency Dr. Shreedhar Paudel 6 th April, 2009.
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Transcript of Micronutrients Deficiency Dr. Shreedhar Paudel 6 th April, 2009.
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Micronutrients Deficiency
Dr. Shreedhar Paudel6th April, 2009
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Vitamin A• Deficiency:-
– blindness-- ↑ childhood and maternal mortality
• Sources:---cod liver oil--shark liver oil--liver--butter, ghee--egg, yolk--carrots, green leafy veg, yellow red veg and
fruits
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Vitamin A
• Fat soluble vitamin
• Cooking, especially frying in oil improves the absorption of carotenes
• Stored in liver
• Zinc is required to mobilise from liver
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Vitamin A • Functions:-
--essential for normal maintenance and function of body tissues for
-vision-cellular integrity-immune competence-growth
--anti-infective vitamin--anti-oxidant property—reduces
incidences of cancer
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C/F of Vitamin A deficiency
• Subclinical deficiency:- increased severity of infections
• Early features:- defective dark adaptation → night blindness
• Xerophthalmia:- on prolonged deficiency presents with a syndrome of xerophthalmia
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C/F of Vitamin A deficiency
Primary signs Secondary signsX1 A Conjunctival xerosis XN Night blindnessX1 B Bitot’s spots XF Fundal changesX2 Corneal xerosis XS Corneal scarringX3 A Corneal ulceration (<1/3 of cornea)X3 B Corneal ulceration (>1/3 of cornea)
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C/F of Vitamin A deficiency
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C/F of Vitamin A deficiency
• Skin– scaly and toad like ( phrynoderma)
• More prone to respiratory infections
• Alteration in mucosa of renal pelvis and urinary bladder predispose to formation of renal and vesical calculi
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Treatment of Vit A deficiency
• Immediately on diagnosis– oral vit A --50,000 International units→ < 6 mo of age--1 lakh → 6-12 months of age--2 lakh → more than 1 yr
-same dose repeated next day and 4 weeks later
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Treatment of Vit A deficiency….
• Local treatment:--antibiotics drops or ointment—3 times
a day to prevent secondary infection in corneal ulcer
-padding eye—prevents dehydration, enhances healing, reduces pain and photophobia
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Prevention of Vit A deficiency
• Infants who are not breastfed– 50,000 IU supplement of vit A by two months of age
• Every infant– one dose of 1 lakh units of vit A along with measles vaccine at 9 months
• Encourage consumption of vit A rich food ( locally available and cheap too—green leafy veg, yellow and orange veg and fruits)
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Vitamin D
• Sources:--fish, liver, oils, yolk of eggs, butter
• Fat soluble vitamin• Function:-
-absorption of calcium from gut-absorption or deposition of calcium
from or to the bone depending on level of calcium in blood
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Vitamin D deficiency• Rickets:-
-craniotabes — ping pong ball like skull bones
-large anterior fontanelle
-bossing of frontal bones
-rachitic rosary—prominent costochondral junction
-pigeon breast—sternum projecting forward
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Vitamin D deficiency• Rickets:-
-Harrison’s groove—horizontal depression on lower border of chest (corresponding to insertion of diaphragm)
-delayed eruption of primary teeth
-deformation of long bones when child start bearing body wt
-protuberant abdomen—pot belly
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Vit D deficiency
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Vitamin D deficiency….• Rickets diagnosis:-
-clinical manifestations
-x-ray changes in lower ends of radius and ulna → cup shaped depression
-larger gap between epiphyses and metaphyses
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Vitamin D deficiency….• Management of rickets:-
-supplementation of vit D (oral or IM)-deformities of bone → orthopedic
measures
• If vit D deficiency is present along with PEM:- once the child starts gaining weight, vitamin D will be required to support growth (400 IU/day)
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Iron deficiency
• Iron deficiency anaemia is responsible for a fifth of early neonatal mortality
• Also affects growth and development• Limits the learning capacity• Reduces cognitive development• Reduces work capacity of the affected
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Iron deficiency• Maternal anemia is associated with intrauterine growth
retardation, premature delivery, increased fetal loss
• Prevented by antenatal supplementation of iron capsules
• Iron rich diet—child, mother
• If deficiency is present along with PEM iron in the form of ferrous sulphate can be given but only after 7 days of admission when the child is on the way to recovery
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Iodine Deficiency Disorders• Iodine deficiency in pregnancy → cretinism
and possible fetal wastage• Wide spectrum of effects on growth and
development--endemic goitre--endemic cretinism--impaired mental function--increased stillbirths and perinatal and infant mortality
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Iodine deficiency disorders
• Seafoods and vegetables grown on iodine rich soil are good sources
• Goitrogens– maize, bamboo shoots, sweet potatoes, cauliflower, cabbage
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Iodine deficiency disorders• Clinical features:-
--abortion and still birth--congenital anomalies--neurological and myxedematous
cretinism--psychomotor defects in newborn--juvenile hypothyroidism--impaired mental function--retardation of physical and sexual growth
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Iodine deficiency disorders
• Clinical features:---Neurological cretinism → deaf-mutism,
rigid extremities, gait disturbances
--Myxedematous cretinism → retarded psychomotor development, short stature, coarse facial features but without deaf mutism
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Iodine deficiency disorders• Management:-
--prevention- iodinated salt, iodized oil
--treatment with iodine or thyroxine—eliminate signs of hypothyroidism but neuromotor and intellectual deficiency are irreversible
--so prevention is the best management
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ZINC
• Zinc is present in all organs, tissues, fluids and secretions of body
• Necessary for RNA, DNA and ribosome stabilization
• Critical for functioning of biomembranes• Supplementation results in improved growth
in children, lower rates of diarrhoea, malaria and pneumonia
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Zinc• Sources:-red meat, pork, cheese, whole wheat,
nuts, legumes
• Deficiency states:- – Growth retardation– Hypogonadism– Anorexia– Alopecia– Acral dermatitis– Enteropathica– Behavioural changes– Increased susceptibility to infections
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Zinc
• Deficiency states in pregnant women:---premature delivery--intrauterine growth retardation--neural tube defects
• Management:- Zinc fortification of diets