Treatment of micronutrients deficiency disorders

  1. Iron:

Risk Group

In general, children aged 6 months through 5 years of age and women of childbearing age especially during pregnancy are the most vulnerable groups. In areas with a high prevalence of hookworm infestation, school-aged children as well as adults can also develop significant iron deficiency

Signs and symptoms of deficiency

As a rule, the only symptoms of iron deficiency anemia are those of the anemia itself. Anemia is defined as an abnormally low concentration of hemoglobin in the blood (below 12 g/100ml in males and 11g/100ml in females)

Signs and symptoms of anemia vary with the degree of severity and chronicity. Mild anemia may be asymptomatic. Possible symptoms include fatigue, weakness, pallor, sensitivity to cold, anorexia, dizziness and headache, stomatitis, glossitis, and thin, spoon shaped fingernails and dysphagia. Many iron deficient patients develop pica, craving for specific foods (ice chips, lettuce, etc.), often not rich in iron. Severe anaemia is defined clinically as a low hemoglobin concentration leading to cardiac decompensation, that is, to the point that the heart cannot maintain adequate circulation of the blood. A common complaint is that individuals feel breathless at rest.

Treatment

In Severe anemia (Hb below 7.0 g/dL): Blood Transfusion

Once an individual is determined to have severe anaemia, a decision must be made regarding whether to treat in the local setting or refer to a hospital or other health facilities where blood transfusion services may be available. Treatment should be given in a hospital if the individual is a pregnant woman beyond 36 weeks gestation (i.e. in the last month of pregnancy) or if signs of respiratory distress or cardiac abnormalities (e.g. labored breathing at rest or Edema) are present.

Other individuals should be treated as indicated as in follows:

Table 19, treatment of iron defeciency anemia

AgeDoseDuration
< 2 Years25 mg iron + 100-400 µg folic acid daily as single dose3 months
2-12 Years60 mg iron + 400 µg folic acid daily as single dose3 months
Adolescents and adults, including pregnant women120 mg iron + 400 µg folic acid daily divided in two doses3 months

Follow up of treated cases

Individuals diagnosed with severe anaemia and treated with oral iron and folate therapy should be asked to return for evaluation 2 weeks after commencement of taken Iron supplement. The purpose of this follow-up is to refer individuals who are in need of further medical attention. Specifically, individuals should be referred to a hospital if their condition has worsened at the 2 week follow-up visit.

 

 

  1. Folic Acid

Folate deficiencies sometimes appear in pregnant women. They need extra folate to meet an increased rate of cell division and thus of DNA (Dioxyribose Nucleic Acid ) synthesis in their own bodies and in the developing fetus.

Risk group

Folic acid deficiency has also been common in people living at poverty level, those with malabsorption disorders or liver disease (cirrhosis), and women taking the birth control pills

Signs and symptoms of deficiency

  • megaloblastic (or macrocytic) anemia which is make all signs and symptoms of an anemia
  • persistent diarrhea

Neural tube defects in the fetus:

  • spins bifida,(paralysis, incontinence, hydrocephalus, and learning disabilities)
  • anencephaly(die shortly after birth)

Treatment

The same as mentioned in iron section.

 

  1. Vitamin A

Risk Group

People who limit their consumption of liver, dairy foods, and beta-carotene-containing vegetables can develop a vitamin A deficiency. VAD is a major cause of mortality among pre-school age children.  The most vulnerable populations are children suffering from: Measles, Diarrhea, Respiratory infections, chickenpox and other severe infections

Signs and symptoms of deficiency

Skin: Poor growth, dryness of skin (Xerosis).

Eye

  • Night blindness
  • Bitot’s spot
  • Corneal xerosis
  • Keratomalacia and Corneal scarring

 

Treatment

Table 20: Treatment of vitamin a deficiency

Treatment schedule for exophthalmia for children
First DoesSecond DoesThird Does
Immediately on diagnosisNext day2 weeks late
Timing based on<6 months of age6 -12 months of age12 months of age
Vitamin A Dosage50,000 IU100,000 IU200,000 IUThe Same age-specified

 

Other specified high-risk illnesses:

All children with measles, severe protein-energy malnutrition, and chronic diarrhoeal diseases have an increased risk of Vitamin A Deficiency (VAD). The recommended doses for these cases are:

Table 21: Vitamin a dosage for children at high risk

Condition/ age groupDosesTiming
Measles

6-12 months of age

12 months of age

 

100,000 IU

200,000 IU

 

Age specific doses on the days of one, two and on 14.

 Severe PEM

< 6 months of age

6-12 months of age

12- 59 months of age

50,000 IU

100,000 IU

200,000 IU

 

Age specific doses on the days of one, two and 14.

Chronic diarrheal disease

< 6 months of age

6-12 months of age

12 months to 5 years of age

 

 

50,000 IU

100,000 IU

200,000 IU

 

One dose as per  age specified

 

  1. Vitamin D

 

Risk group

Vitamin D need is greatest at times of rapid growth – that is, in infants and young children, adolescents and pregnant women.

Signs and symptoms of deficiency

Vitamin D deficiency is called rickets if the bones are still growing, and oesteomalacia if the growth process is over.

Signs in babies:

  • The bones of the skull may be soft.
  • The fontanels (soft spot) takes a long time to close.
  • Swelling of the bones in wrists and ankles.
  • The chest may be deformed, and swellings at the ends of the ribs.
  • Repeated respiratory infections.

Signs in children:

  • The skull may look enlarged.
  • The muscles are weak, and the child may learn to walk late.
  • The legs may bend or the child has outward feet and walks like a duck.
  • Sometimes the legs are bent inwards, like “knock knees”.
  • Severe rickets in girls can cause pelvic deformities which can result in difficulties during childbirth.

Osteomalacia:

Symptoms include:

  • Sever pain in the bones;
  • Muscle weakness;
  • Deformity of the pelvis, causing difficulties in childbirth;
  • Broken bones, especially in people who are old or disabled.

 

Treatment:

To treat a child with rickets, the child could be made to stay in the sun for 30 minutes each day for about a month. This is best done early morning or evening as the sun rays are not harmful at that time.

  1. Vitamin C

Risk group

Vitamin C deficiency occurs in people, who do not consume enough vitamin C, including:

  • Refugees who cannot get fresh fruits and vegetables.
  • People who live in dry areas where no fresh fruit and vegetables are available. This also happens during a drought.
  • Absence/reduced access to local markets and/or purchasing power to buy fresh vegetables and fruits.
  • Infectious diseases that spread quickly and thereby deplete body stores and/or increase requirement.
  • Population dependent entirely on external food aid that doesn’t contain vitamin C for long periods.
  • Increased risk among older persons and unmarried men who live alone and women of reproductive age, especially pregnant and lactating, and adults with heavy physical activity.

Signs/ Symptoms and case definition of Scurvy

Before scurvy is observed, vitamin C deficient individuals have less clear symptoms which include:

  • lassitude,
  • weakness and irritability,
  • vague dull aching pains in the muscles or joints of the legs and feet,
  • weight loss and reduced work capacity,

Case Definition

Scurvy is defined as a disease occurring after prolonged deprivation of Vitamin C containing foods and is characterized as follows:

In adults and adolescents

  • Internal Hemorrhage
  • Joint and muscle pain (legs & feet)
  • Joint swelling
  • Bleeding gum (can be swollen)
  • Reduced mobility
  • Reduced work capacity
  • Anemia

In children

  • General irritability
  • Tiredness in the limbs, especially the legs
  • Pseudo paralysis (legs)
  • hemorrhage around erupting teeth

In extreme cases, scurvy can also be fatal

Curative treatment

Adult: 500 –1000mg Vitamin C tablets daily divided over 3 doses for 2 – 3 weeks

Children: 100 – 300 mg Vitamin C tablets daily divided in 3 doses for 2 – 3 weeks

Local treatment: Proper wound care, use gentian violet

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