eMedicine Specialties > Endocrinology > Metabolic Disorders

Vitamin A Deficiency: Differential Diagnoses & Workup

Author: George Ansstas, MD, Chief Resident, Department of Internal Medicine, Saint Louis University Hospital; Assistant Professor, Department of Internal Medicine, Saint Louis University
Coauthor(s): Jigna Thakore, MD, Fellow, Department of Gastroenterology, Dayton Veterans Administration Medical Center; N Gopalswamy, MD, Chairman, Professor of Internal Medicine, Department of Gastroenterology, Wright State University/Veterans Affairs Medical Center
Contributor Information and Disclosures

Updated: Jun 16, 2008

Differential Diagnoses

Hypothyroidism

Other Problems to Be Considered

Refractory errors
Zinc deficiency

Workup

Laboratory Studies

  • A serum retinol study is a costly but direct measure using high-performance liquid chromatography. A value of less than 0.7 mg/L in children younger than 12 years is considered low.
  • A serum RBP study is easier to perform and less expensive than a serum retinol study, because RBP is a protein and can be detected by an immunologic assay. RBP is also a more stable compound than retinol with respect to light and temperature. However, RBP levels are less accurate, because they are affected by serum protein concentrations and because types of RBP cannot be differentiated.12,13,14
  • A zinc level is useful because zinc deficiency interferes with RBP production.
  • An iron panel is useful because iron deficiency can affect the metabolism of vitamin A.
  • Albumin levels are indirect measures of vitamin A levels.
  • Obtain a complete blood count (CBC) with differential if anemia, infection, or sepsis is a possibility.
  • An electrolyte evaluation and liver function studies should be performed to evaluate for nutritional and volume status.

Imaging Studies

  • In children, radiographic films of the long bones may be useful when an evaluation is being made for bone growth and for excessive deposition of periosteal bone.

Procedures

  • Dark-adaptation threshold should be tested.15

More on Vitamin A Deficiency

Overview: Vitamin A Deficiency
Differential Diagnoses & Workup: Vitamin A Deficiency
Treatment & Medication: Vitamin A Deficiency
Follow-up: Vitamin A Deficiency
References
Further Reading
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References

  1. Combs GF Jr. Vitamins. In: Mahan LK, Escott-Stump S, eds. Krause's Food, Nutrition, and Diet Therapy. 10th ed. Philadelphia, Pa: WB Saunders; 2000.

  2. Pazirandeh S, Burns DL. Overview of fat-soluble vitamins I. UpToDate. 2002.

  3. Russell RM. Vitamin and trace mineral deficiency and excess. In: Braunwald E, Fauci A, Kasper D, et al, eds. Harrison's Principles of Internal Medicine. vol 1. 15th ed. New York, NY: McGraw-Hill; 2001:465-6.

  4. Munoz EC, Rosado JL, Lopez P, et al. Iron and zinc supplementation improves indicators of vitamin A status of Mexican preschoolers. Am J Clin Nutr. Mar 2000;71(3):789-94. [Medline]. [Full Text].

  5. Reddy V. History of the International Vitamin A Consultative Group 1975-2000. J Nutr. Sep 2002;132(9 Suppl):2852S-6S. [Medline]. [Full Text].

  6. D'Souza RM, D'Souza R. Vitamin A for treating measles in children. Cochrane Database Syst Rev. 2002;(1):CD001479. [Medline].

  7. Gungor S, Olmez A, Pinar Arikan Firat, et al. Serum retinol and beta-carotene levels in subacute sclerosing panencephalitis. J Child Neurol. Mar 2007;22(3):341-3. [Medline].

  8. Rothman KJ, Moore LL, Singer MR, et al. Teratogenicity of high vitamin A intake. N Engl J Med. Nov 23 1995;333(21):1369-73. [Medline]. [Full Text].

  9. Alaimo K, McDowell MA, Briefel RR, et al. Dietary intake of vitamins, minerals, and fiber of persons ages 2 months and over in the United States: Third National Health and Nutrition Examination Survey, Phase 1, 1988-91. Adv Data. Nov 14 1994;1-28. [Medline]. [Full Text].

  10. Lee V, Ahmed F, Wada S, et al. Extent of vitamin A deficiency among rural pregnant women in Bangladesh. Public Health Nutr. Jun 12 2008;1-6. [Medline].

  11. Al-Saleh I, El-Doush I, Billedo G. Age and gender-related reference values for serum dl-alpha-tocopherol and all-trans-retinol levels in Saudi population. Int J Vitam Nutr Res. Sep 2007;77(5):326-35. [Medline].

  12. de Pee S, Dary O. Biochemical indicators of vitamin A deficiency: serum retinol and serum retinol binding protein. J Nutr. Sep 2002;132(9 Suppl):2895S-901S. [Medline]. [Full Text].

  13. Weinman AR, Jorge SM, Martins AR, et al. Assessment of vitamin A nutritional status in newborn preterm infants. Nutrition. Jun 2007;23(6):454-60. [Medline].

  14. Gorstein JL, Dary O, Pongtorn, et al. Feasibility of using retinol-binding protein from capillary blood specimens to estimate serum retinol concentrations and the prevalence of vitamin A deficiency in low-resource settings. Public Health Nutr. May 2008;11(5):513-20. [Medline].

  15. Russell RM. The vitamin A spectrum: from deficiency to toxicity. Am J Clin Nutr. Apr 2000;71(4):878-84. [Medline]. [Full Text].

  16. Dietary Guidelines for Americans, 2005. 6th ed. Department of Health and Human Services, Department of Agriculture; Jan 2005. [Full Text].

  17. Dietary Supplement Fact Sheet: Vitamin A and Carotenoids. National Institutes of Health, Office of Dietary Supplements; Apr 23 2006. [Full Text].

  18. Fletcher RH, Fairfield KM. Vitamin supplementation in disease prevention II. UpToDate. 2002.

  19. Fairfield KM, Fletcher RH. Vitamins for chronic disease prevention in adults: scientific review. JAMA. Jun 19 2002;287(23):3116-26. [Medline]. [Full Text].

  20. Willett WC, Hunter DJ. Vitamin A and cancers of the breast, large bowel, and prostate: epidemiologic evidence. Nutr Rev. Feb 1994;52(2 Pt 2):S53-9. [Medline].

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Further Reading

Related eMedicine topics:
 Avitaminosis A
Malnutrition
Vitamin A Toxicity

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Keywords

VAD, retinoic acid, retinol, beta carotene, beta-carotene, Aquasol A, Palmitate-A, Oleovitamin A, carotenoids, provitamin A, 11-cis -retinol, vision, dark adaptation, nyctalopia, retinol-binding protein, RBP, cellular retinol-binding protein, CRBP, cystic fibrosis, sprue, pancreatic insufficiency, inflammatory bowel disorder, IBD, inflammatory bowel disease, cholestasis, alcoholism, Bitot spots, dry skin, dry hair, pruritus, broken fingernails, keratomalacia, xerophthalmia, follicular hyperkeratosis, phrynoderma, vitamin deficiency, malnutrition, retinoids, retinoid deficiency, deficiency of vitamin A

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Contributor Information and Disclosures

Author

George Ansstas, MD, Chief Resident, Department of Internal Medicine, Saint Louis University Hospital; Assistant Professor, Department of Internal Medicine, Saint Louis University
George Ansstas, MD is a member of the following medical societies: American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Jigna Thakore, MD, Fellow, Department of Gastroenterology, Dayton Veterans Administration Medical Center
Jigna Thakore, MD is a member of the following medical societies: American College of Gastroenterology and American Society of Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

N Gopalswamy, MD, Chairman, Professor of Internal Medicine, Department of Gastroenterology, Wright State University/Veterans Affairs Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Udaya M Kabadi, MD, Professor, Department of Medicine, University of Iowa College of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Romesh Khardori, MD, Chief, Division of Endocrinology, Metabolism and Molecular Medicine, Professor, Department of Internal Medicine, Southern Illinois University School of Medicine
Romesh Khardori, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Medical Association, American Society of Andrology, Endocrine Society, and Illinois State Medical Society
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD, Professor of Medicine, St Louis University School of Medicine
George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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